Provider Demographics
NPI:1730313982
Name:GOODRICH, ANNE K (LPN)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:K
Last Name:GOODRICH
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 1:561 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-3049
Mailing Address - Country:US
Mailing Address - Phone:937-451-1236
Mailing Address - Fax:
Practice Address - Street 1:561 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-3049
Practice Address - Country:US
Practice Address - Phone:937-451-1236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-02
Last Update Date:2009-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH126951164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse