Provider Demographics
NPI:1194512442
Name:GOODWIN, MONE ANDREA
Entity type:Individual
Prefix:
First Name:MONE
Middle Name:ANDREA
Last Name:GOODWIN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 E 253RD ST
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44132-1831
Mailing Address - Country:US
Mailing Address - Phone:440-529-7808
Mailing Address - Fax:
Practice Address - Street 1:535 E 253RD ST
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132-1831
Practice Address - Country:US
Practice Address - Phone:440-529-7808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant