Provider Demographics
NPI:1841755329
Name:GOODELL, DANIELLE LEE (CNP)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:LEE
Last Name:GOODELL
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:LEE
Other - Last Name:D'AMATO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15500 S TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-5520
Mailing Address - Country:US
Mailing Address - Phone:419-843-8815
Mailing Address - Fax:419-843-8816
Practice Address - Street 1:7247 W CENTRAL AVE STE A
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43617-1178
Practice Address - Country:US
Practice Address - Phone:419-843-8815
Practice Address - Fax:419-843-8816
Is Sole Proprietor?:No
Enumeration Date:2019-02-08
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704231348363LA2100X
OH023909363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH023909OtherOHIO LICENSE
MI4704231348OtherMI LICENSE