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NPI Code Detail

MEDICARE: DEBORAH LEE GOODWIN LMP, MMP, NCTM

MEDICARE: DEBORAH LEE GOODWIN LMP, MMP, NCTM
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
1174400000XSpecialistMA00024747WA

General Provider Information

NPI Number : 1417137886
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEBORAH LEE GOODWIN LMP, MMP, NCTM
Provider Business Mailing Address
First Line : PO BOX 65188
Second Line :
City : VANCOUVER
State : WA
Zip : 98665-0007
Country : US
Telephone Number : 360-798-3917
Fax Number : 360-574-9934
Provider Business Practice Location Address
First Line : 410 E 20TH ST
Second Line :
City : VANCOUVER
State : WA
Zip : 98663-3316
Country : US
Telephone Number : 360-798-3917
Fax Number : 360-574-9934
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/13/2007
Last Update Date : 11/06/2009

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