Basic Information
| Provider Information | |||||||||
| NPI: | 1598378705 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOODELL | ||||||||
| FirstName: | YUKIKO | ||||||||
| MiddleName: | KOBAYASHI | ||||||||
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| Credential: | ANP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4105 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972084105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8669071068 | ||||||||
| FaxNumber: | 4259179141 | ||||||||
| Practice Location | |||||||||
| Address1: | 3300 PROVIDENCE DR STE B104 | ||||||||
| Address2: | |||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995084690 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9072127997 | ||||||||
| FaxNumber: | 9072128225 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2020 | ||||||||
| LastUpdateDate: | 05/26/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP2300X | 3010 | HI | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care | 163WG0600X | 183261 | AK | Y | Nursing Service Providers | Registered Nurse | Gerontology |
No ID Information.