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General NPI Number Information
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NPI Number | 1255292017
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Entity Type | Individual
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Provider Name | LAURA LYNN GOODWIN
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Gender | Female
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Dates
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Enumeration Date | 11/20/2025
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Last Update Date | 11/20/2025
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Provider Practice Location Address
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Address Line | 6020 BROADWAY ST
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City | QUINCY
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State | IL
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Zip | 62305-7919
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Country | US
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Telephone | 217-224-3366
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Fax | 217-221-6189
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Provider Business Mailing Address
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Address Line | 1331 RIM RD
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City | QUINCY
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State | IL
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Zip | 62305-8049
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Country | US
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Telephone | 217-224-3366
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Fax | 217-221-6189
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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 | 163WC0400X
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Taxonomy Name | Case Management Registered Nurse
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License Number | 014245357
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License Number State | IL
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