Provider Demographics
NPI:1083394407
Name:GOOD, STEPHANIE L
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:L
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 1:315 PARKVIEW DR LOT 105
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-4911
Mailing Address - Country:US
Mailing Address - Phone:419-619-3952
Mailing Address - Fax:
Practice Address - Street 1:315 PARKVIEW DR LOT 105
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-4911
Practice Address - Country:US
Practice Address - Phone:419-619-3952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-20
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty