MEDICARE: TERRIE GOLDBERG RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	431932	OH

General Provider Information

NPI Number	:	1538811880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRIE GOLDBERG RN

Provider Business Mailing Address
First Line	:	5 SEVERANCE CIR STE 101
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-1513
Country	:	US
Telephone Number	:	216-859-8300
Fax Number	:	920-926-0060

Provider Business Practice Location Address
First Line	:	5 SEVERANCE CIR STE 101
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44118-1513
Country	:	US
Telephone Number	:	216-859-8300
Fax Number	:	920-926-0060

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2022
Last Update Date	:	01/18/2022

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