Provider Demographics
NPI:1407180953
Name:GOODIN, ANNETTE L (DI)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:L
Last Name:GOODIN
Suffix:
Gender:F
Credentials:DI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 BRANDON DR
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-4253
Mailing Address - Country:US
Mailing Address - Phone:606-523-1974
Mailing Address - Fax:606-523-1974
Practice Address - Street 1:212 BRANDON DR
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-4253
Practice Address - Country:US
Practice Address - Phone:606-523-1974
Practice Address - Fax:606-523-1974
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-30
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist