MEDICARE: GODDESS MINGO APRN, FNP-BC

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	164W00000X	Licensed Practical Nurse	156494	OH
2	163W00000X	Registered Nurse	422797	OH
3	363L00000X	Nurse Practitioner	0040242	OH

General Provider Information

NPI Number	:	1720488091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GODDESS MINGO APRN, FNP-BC

Provider Business Mailing Address
First Line	:	9462 ACKLEY RD
Second Line	:
City	:	PARMA HEIGHTS
State	:	OH
Zip	:	44130-2327
Country	:	US
Telephone Number	:	440-731-5887
Fax Number	:

Provider Business Practice Location Address
First Line	:	6001 STATE RD
Second Line	:
City	:	PARMA
State	:	OH
Zip	:	44134-2869
Country	:	US
Telephone Number	:	440-731-5887
Fax Number	:

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

Provider Enumeration Date	:	08/24/2014
Last Update Date	:	01/12/2026

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