Provider Demographics
NPI:1851667158
Name:GOINES, BRANDY NICOLE
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:NICOLE
Last Name:GOINES
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 1:10105 HUNTER CT
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215-1717
Mailing Address - Country:US
Mailing Address - Phone:513-628-5959
Mailing Address - Fax:
Practice Address - Street 1:10105 HUNTER CT
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45215-1717
Practice Address - Country:US
Practice Address - Phone:513-628-5959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401019421209376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide