Provider Demographics
NPI:1447286687
Name:GOOD, DOREEN MAY (CRNP)
Entity type:Individual
Prefix:MRS
First Name:DOREEN
Middle Name:MAY
Last Name:GOOD
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MRS
Other - First Name:DOREEN
Other - Middle Name:MAY
Other - Last Name:GOOD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNS
Mailing Address - Street 1:2343 DALTON FOX LAKE RD
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44618-9456
Mailing Address - Country:US
Mailing Address - Phone:330-495-6919
Mailing Address - Fax:
Practice Address - Street 1:2600 6TH ST SE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44710
Practice Address - Country:US
Practice Address - Phone:330-363-9729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34421428363L00000X
OH364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Not Answered364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2377799Medicaid
MG0956459OtherDEA
P02258Medicare UPIN