Provider Demographics
NPI:1023611399
Name:GOOD, NICOLE MARIE (RN, HWNC-BC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:GOOD
Suffix:
Gender:F
Credentials:RN, HWNC-BC
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:GOOD
Other - Last Name:PIOTROWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10337 S PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-2824
Mailing Address - Country:US
Mailing Address - Phone:815-207-3872
Mailing Address - Fax:
Practice Address - Street 1:10337 S PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-2824
Practice Address - Country:US
Practice Address - Phone:815-207-3872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041402716163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Single Specialty