Provider Demographics
NPI:1104968254
Name:GOOD, KAREN LEE (LPN)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:LEE
Last Name:GOOD
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 1:13915 DRURY RD
Mailing Address - Street 2:
Mailing Address - City:CENTERBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43011-9311
Mailing Address - Country:US
Mailing Address - Phone:614-204-5010
Mailing Address - Fax:
Practice Address - Street 1:13915 DRURY RD
Practice Address - Street 2:
Practice Address - City:CENTERBURG
Practice Address - State:OH
Practice Address - Zip Code:43011-9311
Practice Address - Country:US
Practice Address - Phone:614-204-5010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 046256164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2084417Medicaid