Provider Demographics
NPI:1073675757
Name:GOOD, LINSEY M
Entity Type:Individual
Prefix:
First Name:LINSEY
Middle Name:M
Last Name:GOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39056 FOREST ST
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:OH
Mailing Address - Zip Code:44432-9362
Mailing Address - Country:US
Mailing Address - Phone:330-831-1070
Mailing Address - Fax:330-420-0088
Practice Address - Street 1:39056 FOREST ST
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:OH
Practice Address - Zip Code:44432-9362
Practice Address - Country:US
Practice Address - Phone:330-831-1070
Practice Address - Fax:330-420-0088
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2658977374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH100305333599Medicaid