MEDICARE: CANANDRA GOODALL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747A0650X	Attendant Care Provider		IN
2	3747A0650X	Attendant Care Provider	23016345-1	IN

General Provider Information

NPI Number	:	1225886856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANANDRA GOODALL

Provider Business Mailing Address
First Line	:	9165 OTIS AVE STE 229
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46216-2321
Country	:	US
Telephone Number	:	317-455-6744
Fax Number	:

Provider Business Practice Location Address
First Line	:	9165 OTIS AVE STE 229
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46216-2321
Country	:	US
Telephone Number	:	317-455-6744
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2024
Last Update Date	:	07/31/2024

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Directions to “ CANANDRA GOODALL ” Practice Location

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