=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295255610
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DONNA GOODWIN APRN, CNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/27/2017
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 36711 AMERICAN WAY SUITE A
-----------------------------------------------------
City | AVON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-653-8091
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3755 ORANGE PL STE 101
-----------------------------------------------------
City | BEACHWOOD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44122-4455
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-455-3353
-----------------------------------------------------
Fax | 216-450-1810
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | APRN.CNP.021061
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------