Provider Demographics
NPI:1629282959
Name:GOODWIN, CONTESSA LEE (PROVIDER)
Entity Type:Individual
Prefix:MRS
First Name:CONTESSA
Middle Name:LEE
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177-1352
Mailing Address - Country:US
Mailing Address - Phone:937-655-7432
Mailing Address - Fax:
Practice Address - Street 1:151 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-1352
Practice Address - Country:US
Practice Address - Phone:937-655-7432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2664791OtherSTATE PROVIDER NUMBER