Provider Demographics
NPI:1942063060
Name:GOOD, JULIE ANNE (STNA)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANNE
Last Name:GOOD
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANNE
Other - Last Name:UNSWORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5290 ISCH RD
Mailing Address - Street 2:
Mailing Address - City:WALBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43465-9711
Mailing Address - Country:US
Mailing Address - Phone:419-266-9612
Mailing Address - Fax:
Practice Address - Street 1:757 E SHORELINE DR
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43528-9355
Practice Address - Country:US
Practice Address - Phone:419-266-9612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401724360215376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide