| Doctor Name: | TARA R GOODMAN |
| NPI Number: | 1003102187 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ARNP |
| License Number: | C107297 |
| Business Practice Address: | 1219 Main St Hamburg, IA - 516401300 |
| Business Phone Number: | 7123822626 |
| Business Fax Number: | 7123821931 |
| Mailing Address: | 1219 Main St, HAMBURG |
| State: | IA |
| Postal Code: | 516401300 |
| Phone Number: | 7123822626 |
| Fax Number: | 7123821931 |
| NPI Enumeration Date: | 06/27/2011 |
| NPI Last Update Date: | 06/27/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | C107297 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |