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General NPI Number Information
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NPI Number | 1548042245
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Entity Type | Individual
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Provider Name | MRS. LISA DIANE GOODE
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Gender | Female
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Dates
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Enumeration Date | 10/17/2023
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Last Update Date | 10/17/2023
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Provider Practice Location Address
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Address Line | 502 CHESTNUT ST
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City | GREENFIELD
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State | IL
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Zip | 62044-1305
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Country | US
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Telephone | 217-368-2667
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Fax | 217-368-3140
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Provider Business Mailing Address
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Address Line | 502 CHESTNUT ST
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City | GREENFIELD
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State | IL
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Zip | 62044-1305
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Country | US
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Telephone | 217-368-2667
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Fax | 217-368-3140
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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