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General NPI Number Information
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NPI Number | 1093362170
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Entity Type | Individual
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Provider Name | RACHEL LAUREN GOODWYN ACNPC-AG
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Gender | Female
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Dates
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Enumeration Date | 08/22/2019
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Last Update Date | 08/24/2021
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Provider Practice Location Address
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Address Line | 13460 N 94TH DR STE J1
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City | PEORIA
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State | AZ
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Zip | 85381-4246
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Country | US
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Telephone | 623-876-8816
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Fax | 623-298-0168
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Provider Business Mailing Address
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Address Line | 13460 N 94TH DR STE J1
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City | PEORIA
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State | AZ
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Zip | 85381-4246
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Country | US
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Telephone | 623-876-8816
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Fax | 623-298-0168
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 57242
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 246985
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License Number State | AZ
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