Healthcare Provider Details

I. General information

NPI: 1295255610
Provider Name (Legal Business Name): DONNA GOODWIN APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 07/21/2022
Certification Date: 12/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36711 AMERICAN WAY SUITE A
AVON OH
44011
US

IV. Provider business mailing address

3755 ORANGE PL STE 101
BEACHWOOD OH
44122-4455
US

V. Phone/Fax

Practice location:
  • Phone: 440-653-8091
  • Fax:
Mailing address:
  • Phone: 440-455-3353
  • Fax: 216-450-1810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.021061
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: