Provider Demographics
NPI:1891368692
Name:GOODELL, HOLLIE
Entity type:Individual
Prefix:
First Name:HOLLIE
Middle Name:
Last Name:GOODELL
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:OHIO UNIVERSITY MEDICAL EDUCATION CENTER
Mailing Address - Street 2:163 WEST UNION STREET
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701
Mailing Address - Country:US
Mailing Address - Phone:740-591-8730
Mailing Address - Fax:
Practice Address - Street 1:MEDICAL EDUCATION CENTER
Practice Address - Street 2:169 WEST UNION STREET
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701
Practice Address - Country:US
Practice Address - Phone:740-566-0608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-20
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH508543163W00000X, 163WD0400X
171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163W00000XNursing Service ProvidersRegistered Nurse
No171400000XOther Service ProvidersHealth & Wellness Coach