Healthcare Provider Details

I. General information

NPI: 1316685282
Provider Name (Legal Business Name): GRACE ANNE GOODWIN MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2022
Last Update Date: 05/21/2022
Certification Date: 05/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 BEECHMONT AVE
CINCINNATI OH
45230-4119
US

IV. Provider business mailing address

3 MYNAH DR
AMELIA OH
45102-2183
US

V. Phone/Fax

Practice location:
  • Phone: 513-232-9100
  • Fax:
Mailing address:
  • Phone: 615-957-5062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0031102
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: