1447286687 NPI number — MRS. DOREEN MAY GOOD CRNP

Table of content: MRS. DOREEN MAY GOOD CRNP (NPI 1447286687)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447286687 NPI number — MRS. DOREEN MAY GOOD CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOOD
Provider First Name:
DOREEN
Provider Middle Name:
MAY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GOOD
Provider Other First Name:
DOREEN
Provider Other Middle Name:
MAY
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
CNS
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1447286687
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2343 DALTON FOX LAKE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44618-9456
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-495-6919
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2600 6TH ST SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-363-9729
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  34421428 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 364S00000X , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2377799 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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