Provider Demographics
NPI:1871903989
Name:ERIN ROONEY-GODIN
Entity type:Organization
Organization Name:ERIN ROONEY-GODIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ROONEY-GODIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN,BSN
Authorized Official - Phone:414-573-7000
Mailing Address - Street 1:2724 NORTHVIEW RD UNIT 41
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-2035
Mailing Address - Country:US
Mailing Address - Phone:414-573-7000
Mailing Address - Fax:
Practice Address - Street 1:2724 NORTHVIEW RD UNIT 41
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-2035
Practice Address - Country:US
Practice Address - Phone:414-573-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-29
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI156229-30302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1944Medicaid