Healthcare Provider Details

I. General information

NPI: 1487124061
Provider Name (Legal Business Name): AMY LYNN GOODWIN RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY LYNN FRAME RD

II. Dates (important events)

Enumeration Date: 11/27/2018
Last Update Date: 11/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 S 6TH AVE
TUCSON AZ
85723
US

IV. Provider business mailing address

841 E COTTONWOOD CANYON PLACE
SAHUARITA AZ
85629
US

V. Phone/Fax

Practice location:
  • Phone: 520-792-1450
  • Fax:
Mailing address:
  • Phone: 520-468-8696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number1077060
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: