Provider Demographics
NPI:1548990229
Name:GOODHART, DAVID PAUL (RN)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:PAUL
Last Name:GOODHART
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 BROAD AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-2464
Mailing Address - Country:US
Mailing Address - Phone:330-801-4194
Mailing Address - Fax:
Practice Address - Street 1:20611 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44117-1521
Practice Address - Country:US
Practice Address - Phone:855-967-2436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.466778163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency