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General NPI Number Information
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NPI Number | 1053750844
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Entity Type | Individual
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Provider Name | BRUCE WAYNE GODWIN RN, COHN-S
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Gender | Male
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Dates
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Enumeration Date | 06/14/2013
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Last Update Date | 06/14/2013
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Provider Practice Location Address
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Address Line | 480 CENTRAL AVE. NAVAL HEALTH CLINIC HAWAII
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City | JBPHH
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State | HI
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Zip | 96860
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Country | US
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Telephone | 808-474-4242
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Fax | 808-471-1437
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Provider Business Mailing Address
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Address Line | 480 CENTRAL AVE. NAVAL HEALTH CLINIC HAWAII
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City | JBPHH
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State | HI
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Zip | 96860
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Country | US
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Telephone | 808-474-4242
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Fax | 808-471-1437
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WX0106X
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Taxonomy Name | Occupational Health Registered Nurse
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License Number | RN35705
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 163WX0106X
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Taxonomy Name | Occupational Health Registered Nurse
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License Number | 520972
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License Number State | CA
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