Provider Demographics
NPI:1154578722
Name:GOODWIN, HEIDI A (MSN CNM CNP)
Entity type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:A
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:MSN CNM CNP
Other - Prefix:MS
Other - First Name:HEIDI
Other - Middle Name:A
Other - Last Name:LAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN CNP CNP CBCN
Mailing Address - Street 1:3909 ORANGE PL STE 4400
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4482
Mailing Address - Country:US
Mailing Address - Phone:216-844-0080
Mailing Address - Fax:216-896-1776
Practice Address - Street 1:3909 ORANGE PLACE
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122
Practice Address - Country:US
Practice Address - Phone:216-844-0080
Practice Address - Fax:216-844-7874
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.10210-NM367A00000X
OHCOA.10997-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2888068Medicaid
OHP00972483OtherRAILROAD MEDICARE
OH0062218Medicaid
OHNP34001Medicare PIN