MEDICARE: AMANDA 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
1	133N00000X	Nutritionist

General Provider Information

NPI Number	:	1588523393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA GOODWIN

Provider Business Mailing Address
First Line	:	37307 N 17TH AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85086-9592
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	37307 N 17TH AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85086-9592
Country	:	US
Telephone Number	:	480-489-7592
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2026
Last Update Date	:	01/17/2026

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