Healthcare Provider Details

I. General information

NPI: 1700516028
Provider Name (Legal Business Name): E'SHIRA M GOODEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2022
Last Update Date: 06/10/2022
Certification Date: 06/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1057 ACADEMY AVE
CINCINNATI OH
45205-1676
US

IV. Provider business mailing address

1057 ACADEMY AVE
CINCINNATI OH
45205-1676
US

V. Phone/Fax

Practice location:
  • Phone: 513-238-9585
  • Fax:
Mailing address:
  • Phone: 513-238-9585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: