IndividualActive
Blaine Goodman
NPI 1104483718 · Certified Registered Nurse Anesthetist · Rolla, MO
Provider details
- NPI number
- 1104483718
- Entity type
- Individual
- Primary specialty
- Certified Registered Nurse AnesthetistPhysician Assistants & Advanced Practice Nursing Providers
- Sex
- Male
- Sole proprietor
- No
- License
- 2019012508 (MO)
Mailing address
829 Oak Knoll Rd
Rolla, MO 65401-4715
Registry dates
- Enumerated
- 2019-05-20
- Last updated
- 2019-05-20
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.