Provider Demographics
NPI:1336455369
Name:GOOCH, LYDIA (LPN)
Entity type:Individual
Prefix:MS
First Name:LYDIA
Middle Name:
Last Name:GOOCH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:988 GREYTON RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44112-3023
Mailing Address - Country:US
Mailing Address - Phone:440-867-3894
Mailing Address - Fax:
Practice Address - Street 1:988 GREYTON RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HTS,
Practice Address - State:OH
Practice Address - Zip Code:44112
Practice Address - Country:US
Practice Address - Phone:440-867-3894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 110232164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse