Provider Demographics
NPI:1548042245
Name:GOODE, LISA DIANE
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:DIANE
Last Name:GOODE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62044-1305
Mailing Address - Country:US
Mailing Address - Phone:217-368-2667
Mailing Address - Fax:217-368-3140
Practice Address - Street 1:502 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IL
Practice Address - Zip Code:62044-1305
Practice Address - Country:US
Practice Address - Phone:217-368-2667
Practice Address - Fax:217-368-3140
Is Sole Proprietor?:No
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker