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NPI Code Detail

MEDICARE: ETHAN RICHARD GOULET

MEDICARE: ETHAN RICHARD GOULET
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
1363LP0808XPsychiatric/Mental Health Nurse PractitionerAPRN.CNP.0042475OH

General Provider Information

NPI Number : 1851248389
Entity Type Code : Individual
Provider Name (Legal Business Name) : ETHAN RICHARD GOULET
Provider Business Mailing Address
First Line : 2600 NAVARRE AVE
Second Line :
City : OREGON
State : OH
Zip : 43616-3207
Country : US
Telephone Number : 419-696-7200
Fax Number :
Provider Business Practice Location Address
First Line : 2600 NAVARRE AVE
Second Line :
City : OREGON
State : OH
Zip : 43616-3207
Country : US
Telephone Number : 419-696-7200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/13/2026
Last Update Date : 06/17/2026

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Directions to “ ETHAN RICHARD GOULET ” Practice Location

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