Provider Demographics
NPI:1659905149
Name:GOODSITE, CYNTHIA KAYE
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:KAYE
Last Name:GOODSITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:OH
Mailing Address - Zip Code:44811-8916
Mailing Address - Country:US
Mailing Address - Phone:419-217-9212
Mailing Address - Fax:
Practice Address - Street 1:1070 MONROE ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:OH
Practice Address - Zip Code:44811-8916
Practice Address - Country:US
Practice Address - Phone:419-217-9212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.146303-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty