Provider Demographics
NPI:1801834668
Name:GOOD, DIANA K
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:K
Last Name:GOOD
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 1:39056 FOREST ST
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:OH
Mailing Address - Zip Code:44432-9362
Mailing Address - Country:US
Mailing Address - Phone:330-831-5527
Mailing Address - Fax:330-420-0088
Practice Address - Street 1:39056 FOREST ST
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:OH
Practice Address - Zip Code:44432-9362
Practice Address - Country:US
Practice Address - Phone:330-831-5527
Practice Address - Fax:330-420-0088
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2599219Medicaid