MRS. PHYLLIS JEAN GOLDBACH (NPI# 1396996682) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396996682 |
| Entity Type | Individual |
| Full Name | MRS. PHYLLIS JEAN GOLDBACH |
| Credential | CNS |
| Practice Address |
401 Bounty Way Apt 209 Avon Lake OH 44012-2479 |
| Practice Telephone | 4409339475 |
| Mailing Telephone | 4409339475 |
| Enumeration Date | 2008-10-04 |
| Last Update Date | 2008-10-04 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 364SP0809X |
Clinical Nurse Specialist Specialization: Psych/Mental Health, Adult |
08973 | OH | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
401 BOUNTY WAY APT 209 |
| City | AVON LAKE |
| State | OH |
| Zip Code | 44012-2479 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649743352 | Wyatt Demarco Massage Therapy & Wellness Center | Massage Therapist | 690 Avon Belden Rd, 2c, Avon Lake, OH 44012 | 2019-01-04 |
| 1659789915 | Self | Home Health | 33803 Electric Blvd, E4, Avonlake, OH 44012 | 2014-07-30 |
| 1427489566 | Thomas Gerosky, D.m.d. Inc | Dentist | 215 Miller Road, Avon Lake, OH 44012 | 2013-11-27 |
| 1558619676 | Lindsay Stein | Counselor | 156a Lear Rd, Avon Lake, OH 44012 | 2012-08-21 |
| 1023388063 | Jennifer Lynn Dorman | Dietitian, Registered | 167 Belmar Boulevard, Avon Lake, OH 44012 | 2012-01-09 |
| 1033495338 | Jessica Rae Wyatt | Massage Therapist | 690 Avon Belden Rd Ste 2c, Avon Lake, OH 44012 | 2011-10-31 |
| 1841599248 | Robin M Hale | Counselor | 32831 Redwood Blvd, Avon Lake, OH 44012 | 2011-03-24 |
| 1265551766 | Robert Day Monroe | Podiatrist | 32118 Augusta Dr, Avon Lake, OH 44012 | 2007-03-28 |
| 1194822908 | John Secrest Pyke IIi | Dentist | 33399 Walker Rd, Suite D, Avon Lake, OH 44012 | 2006-09-20 |
| 1295842284 | Westshore Primary Care Assoc Inc | Internal Medicine | 32730 Walker Road, Building H, Avon Lake, OH 44012 | 2006-08-24 |
| Find all providers in zip 44012 | ||||
| Taxonomy Code | 364SP0809X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Clinical Nurse Specialist |
| Specialization | Psych/Mental Health, Adult |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528408788 | Teri Ann Lieser | Clinical Nurse Specialist | 4974 Higbee Ave Nw Ste 209, Canton, OH 44718-2562 | 2013-07-02 |
| 1467602276 | Christopher John Heather | Clinical Nurse Specialist | 975-a Kingsview Dr., Lebanon, OH 45036 | 2008-09-29 |
| 1417134313 | Donna R Laughlin | Clinical Nurse Specialist | 63 Baker Blvd., Akron, OH 44333-3601 | 2008-01-23 |
| 1740476548 | Grace Anastasia Herwig | Clinical Nurse Specialist | 26027 Cobblestone Way, Westlake, OH 44145-2459 | 2007-09-15 |
| 1992854756 | Angela Chesser | Clinical Nurse Specialist | 1670 Upham Dr., Columbus, OH 43210-1250 | 2007-01-10 |
| 1346310687 | Lori Sue Gozdowski | Clinical Nurse Specialist | 1425 Starr Ave., Toledo, OH 43605-1000 | 2006-11-08 |
| 1962580563 | Ellen Doreen Alaimo | Clinical Nurse Specialist | 3167 Fulton Rd, 105, Cleveland, OH 44109-1465 | 2006-11-01 |
| 1619058294 | Caryl A. Eyre | Clinical Nurse Specialist | 2612 Guilford Rd, Cleveland Heights, OH 44118-4108 | 2006-10-18 |
| 1033225404 | Susan Elizabeth Phillips | Clinical Nurse Specialist | 1260 Monroe Avenue, Suite 15h, New Philadelphia, OH 44663 | 2006-08-21 |
| 1770502288 | Roy P Walton | Clinical Nurse Specialist | 1301 Bellefontaine Ave, Lima, OH 45804-3121 | 2006-07-18 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on MRS. PHYLLIS JEAN GOLDBACH.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.