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General NPI Number Information
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NPI Number | 1285698308
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Entity Type | Individual
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Provider Name | AMY NICOLE GOODWINE AU.D.
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Gender | Female
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Dates
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Enumeration Date | 04/14/2006
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Last Update Date | 11/02/2022
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Provider Practice Location Address
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Address Line | 3986 FETTLER PARK DR
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City | DUMFRIES
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State | VA
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Zip | 22025-1997
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Country | US
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Telephone | 703-221-8307
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Fax | 703-221-8548
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Provider Business Mailing Address
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Address Line | 3986 FETTLER PARK DR
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City | DUMFRIES
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State | VA
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Zip | 22025-1997
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Country | US
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Telephone | 703-221-8307
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Fax | 703-221-8548
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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 | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 2201000658
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 237600000X
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Taxonomy Name | Audiologist-Hearing Aid Fitter
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License Number | 2101001172
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License Number State | VA
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