Provider Demographics
NPI:1710397948
Name:GOODWIN, BARBARA (RN)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2755 REDFIELD PLACE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45230
Mailing Address - Country:US
Mailing Address - Phone:513-546-1104
Mailing Address - Fax:
Practice Address - Street 1:2755 REDFIELD PL
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230-1113
Practice Address - Country:US
Practice Address - Phone:513-546-1104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-28
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401433364SH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SH0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH401433Medicaid