Healthcare Provider Details

I. General information

NPI: 1346097995
Provider Name (Legal Business Name): DANIELLE GOODWIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2024
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4903 KAREN ISLE DR
RICHMOND HEIGHTS OH
44143-1412
US

IV. Provider business mailing address

4903 KAREN ISLE DR
RICHMOND HEIGHTS OH
44143-1412
US

V. Phone/Fax

Practice location:
  • Phone: 216-526-0076
  • Fax:
Mailing address:
  • Phone: 216-526-0076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code335G00000X
TaxonomyMedical Foods Supplier
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: