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General NPI Number Information
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NPI Number | 1497208250
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Entity Type | Individual
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Provider Name | BERONICA GOODWIN
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Gender | Female
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Dates
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Enumeration Date | 07/28/2016
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Last Update Date | 11/15/2022
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Provider Practice Location Address
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Address Line | 1102B SUITE #2 4TH AVE SE
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City | DECATUR
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State | AL
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Zip | 35601
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Country | US
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Telephone | 356-822-1300
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Fax |
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Provider Business Mailing Address
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Address Line | 937 SEWELL RD
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City | TRINITY
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State | AL
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Zip | 35673-6625
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Country | US
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Telephone | 256-345-9753
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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 | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number | 16395
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 2-055526
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License Number State | AL
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