Provider Demographics
NPI:1538811880
Name:GOLDBERG, TERRIE (RN)
Entity type:Individual
Prefix:
First Name:TERRIE
Middle Name:
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SEVERANCE CIR STE 101
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-1513
Mailing Address - Country:US
Mailing Address - Phone:216-859-8300
Mailing Address - Fax:920-926-0060
Practice Address - Street 1:5 SEVERANCE CIR STE 101
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-1513
Practice Address - Country:US
Practice Address - Phone:216-859-8300
Practice Address - Fax:920-926-0060
Is Sole Proprietor?:No
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH431932163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse