Provider Demographics
NPI:1063649929
Name:GOODBAR, SHERICE MARIE (LPN)
Entity Type:Individual
Prefix:MS
First Name:SHERICE
Middle Name:MARIE
Last Name:GOODBAR
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5450 HEATHERDOWNS BLVD
Mailing Address - Street 2:APT 4
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-4663
Mailing Address - Country:US
Mailing Address - Phone:419-349-4487
Mailing Address - Fax:
Practice Address - Street 1:5450 HEATHERDOWNS BLVD
Practice Address - Street 2:APT 4
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-4663
Practice Address - Country:US
Practice Address - Phone:419-349-4487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-18
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 134070164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse