Individual
MARY ELLEN GOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.S.
Contact information
Practice address
2615 FORT AMANDA RD, LIMA, OH 45804-3730
(419) 225-7301
Mailing address
PO BOX 951999, CLEVELAND, OH 44193-0021
(419) 996-5114
Taxonomy
Speciality
Code
Description
License number
State
163WD0400X
Diabetes Educator Registered Nurse
Primary
RN-093700 /NS04317
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000200685
ANTHEM BLUE CROSS
OH
Enumeration date
07/12/2006
Last updated
07/08/2007
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