Provider Demographics
NPI:1083256044
Name:GOODE, TINEESHA JANEY (RN)
Entity Type:Individual
Prefix:
First Name:TINEESHA
Middle Name:JANEY
Last Name:GOODE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6876 GREELEY AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45424-1794
Mailing Address - Country:US
Mailing Address - Phone:213-769-9300
Mailing Address - Fax:
Practice Address - Street 1:2010 VIBURNUM CT APT 2A
Practice Address - Street 2:
Practice Address - City:TIPP CITY
Practice Address - State:OH
Practice Address - Zip Code:45371-7532
Practice Address - Country:US
Practice Address - Phone:213-769-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-11
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH460669163W00000X
OHRN.460669163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse