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NPI Code Detail

MEDICARE: KRISTEN JOANN GOODWIN RN

MEDICARE: KRISTEN JOANN GOODWIN RN
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
1163W00000XRegistered Nurse026-0022214VT

General Provider Information

NPI Number : 1467435925
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTEN JOANN GOODWIN RN
Provider Business Mailing Address
First Line : 1060 GAFFNEY RD
Second Line : COMMANDER, USA-MEDDAC-AK, ATTN: MCUC-MMD-QM
City : FT WAINWRIGHT
State : AK
Zip : 99703-5001
Country : US
Telephone Number : 907-353-5418
Fax Number : 907-353-4845
Provider Business Practice Location Address
First Line : 1060 GAFFNEY RD
Second Line : COMMANDER, USA-MEDDAC-AK, ATTN: MCUC-MMD-QM
City : FT WAINWRIGHT
State : AK
Zip : 99703-5001
Country : US
Telephone Number : 907-353-5418
Fax Number : 907-353-4845
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/29/2005
Last Update Date : 07/08/2007

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