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NPI Code Detail

MEDICARE: MRS. GRACIE MAY HUNTER-GOODWIN

MEDICARE: MRS. GRACIE MAY HUNTER-GOODWIN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1164W00000XLicensed Practical NurseLPN16279NV

General Provider Information

NPI Number : 1275302416
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. GRACIE MAY HUNTER-GOODWIN
Provider Business Mailing Address
First Line : 941 CHAPS CIR
Second Line :
City : HENDERSON
State : NV
Zip : 89002-9517
Country : US
Telephone Number : 425-999-0955
Fax Number :
Provider Business Practice Location Address
First Line : 4040 S EASTERN AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89119-0810
Country : US
Telephone Number : 702-763-0300
Fax Number : 702-463-0301
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/28/2023
Last Update Date : 12/28/2023

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Directions to “ MRS. GRACIE MAY HUNTER-GOODWIN ” Practice Location

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