Basic Information
| Provider Information | |||||||||
| NPI: | 1538811880 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOLDBERG | ||||||||
| FirstName: | TERRIE | ||||||||
| MiddleName: | |||||||||
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| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 5 SEVERANCE CIR STE 101 | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND HEIGHTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441181513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2168598300 | ||||||||
| FaxNumber: | 9209260060 | ||||||||
| Practice Location | |||||||||
| Address1: | 5 SEVERANCE CIR STE 101 | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND HEIGHTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441181513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2168598300 | ||||||||
| FaxNumber: | 9209260060 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2022 | ||||||||
| LastUpdateDate: | 01/18/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 01/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 431932 | OH | Y | Nursing Service Providers | Registered Nurse |
No ID Information.