Provider Demographics
NPI:1083058036
Name:GOODALL, CYNTHIA M (LPN)
Entity Type:Individual
Prefix:MR
First Name:CYNTHIA
Middle Name:M
Last Name:GOODALL
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 1:7900 W CALLA RD
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9440
Mailing Address - Country:US
Mailing Address - Phone:330-533-4233
Mailing Address - Fax:
Practice Address - Street 1:7900 W CALLA RD
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-9440
Practice Address - Country:US
Practice Address - Phone:330-533-4233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-22
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN067418164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse