Provider Demographics
NPI:1841755329
Name:GOODELL, DANIELLE LEE (CNP)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:LEE
Last Name:GOODELL
Suffix:
Gender:
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 1:4235 SECOR RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4299
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4126 N HOLLAND SYLVANIA RD STE 105
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3541
Practice Address - Country:US
Practice Address - Phone:419-479-5605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-08
Last Update Date:2025-04-07
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
OH0470987Medicaid
MI4704231348OtherMI LICENSE
OH023909OtherOHIO LICENSE