Provider Demographics
NPI:1639414741
Name:GOOD, ERIN (RD LD)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:GOOD
Suffix:
Gender:F
Credentials:RD LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 EAST HICKMAN ROAD
Mailing Address - Street 2:
Mailing Address - City:WAUKEE
Mailing Address - State:IA
Mailing Address - Zip Code:50263
Mailing Address - Country:US
Mailing Address - Phone:515-216-2770
Mailing Address - Fax:515-987-5963
Practice Address - Street 1:1005 EAST HICKMAN ROAD
Practice Address - Street 2:
Practice Address - City:WAUKEE
Practice Address - State:IA
Practice Address - Zip Code:50263
Practice Address - Country:US
Practice Address - Phone:515-216-2770
Practice Address - Fax:833-719-1241
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-29
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002093133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered