Provider Demographics
NPI:1083957302
Name:GOODMAN, GIVONNA C (STNA)
Entity Type:Individual
Prefix:
First Name:GIVONNA
Middle Name:C
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:GIVONNA
Other - Middle Name:C
Other - Last Name:GOODMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:STNA
Mailing Address - Street 1:27301 SIDNEY DR APT 29
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44132-2958
Mailing Address - Country:US
Mailing Address - Phone:216-201-5986
Mailing Address - Fax:
Practice Address - Street 1:27301 SIDNEY DR APT 29
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132-2958
Practice Address - Country:US
Practice Address - Phone:216-201-5986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-04
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH378853480500374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide