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General NPI Number Information
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NPI Number | 1093593196
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Entity Type | Individual
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Provider Name | SHAWNETTE T GOINES NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 09/19/2023
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Last Update Date | 09/19/2023
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Provider Practice Location Address
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Address Line | 5525 EASTERN AVE
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City | BALTIMORE
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State | MD
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Zip | 21224-2796
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Country | US
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Telephone | 667-328-9051
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Fax |
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Provider Business Mailing Address
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Address Line | 17 KETCH CAY CT
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City | BALTIMORE
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State | MD
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Zip | 21220-7512
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Country | US
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Telephone | 667-328-9051
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R142565
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License Number State | MD
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