Healthcare Provider Details

I. General information

NPI: 1285704601
Provider Name (Legal Business Name): TRENA JILL GOODWIN PMHCNS-BC, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 10/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10200 ALLIANCE RD SUITE 150
BLUE ASH OH
45242-4753
US

IV. Provider business mailing address

9973 TIMBERS DR
CINCINNATI OH
45242-5551
US

V. Phone/Fax

Practice location:
  • Phone: 513-891-0650
  • Fax:
Mailing address:
  • Phone: 513-791-2046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
License NumberRN.121852
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: