Provider Demographics
NPI:1497402358
Name:GOODRIDGE, CHRISTINE MARIE PETTIT (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:MARIE PETTIT
Last Name:GOODRIDGE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 MARKLEY WOODS WAY
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45230-4377
Mailing Address - Country:US
Mailing Address - Phone:513-967-8545
Mailing Address - Fax:
Practice Address - Street 1:955 MARKLEY WOODS WAY
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230-4377
Practice Address - Country:US
Practice Address - Phone:513-967-8545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-09
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ256666363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care