Provider Demographics
NPI:1578716916
Name:GOOD, CALLIE SUE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CALLIE
Middle Name:SUE
Last Name:GOOD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 ST. RT. 4
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:OH
Mailing Address - Zip Code:44811
Mailing Address - Country:US
Mailing Address - Phone:419-483-0608
Mailing Address - Fax:
Practice Address - Street 1:2201 STATE ROUTE 4
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:OH
Practice Address - Zip Code:44811-9742
Practice Address - Country:US
Practice Address - Phone:419-483-0608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN. 1106613164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse