Provider Demographics
NPI:1063684157
Name:GOODLOW, RACHEAL D (LPN)
Entity Type:Individual
Prefix:MRS
First Name:RACHEAL
Middle Name:D
Last Name:GOODLOW
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 1:592 E WHITTIER ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43206-2804
Mailing Address - Country:US
Mailing Address - Phone:614-452-3316
Mailing Address - Fax:
Practice Address - Street 1:592 E WHITTIER ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43206-2804
Practice Address - Country:US
Practice Address - Phone:614-452-3316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 128649164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse