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General NPI Number Information
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NPI Number | 1780252155
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Entity Type | Individual
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Provider Name | ERIN L GOODWIN MS, RD, LD,/N, IBCLC
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Gender | Female
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Dates
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Enumeration Date | 06/14/2021
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Last Update Date | 06/14/2021
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Provider Practice Location Address
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Address Line | 4979 HEALTHY WAY
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City | MARIANNA
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State | FL
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Zip | 32446-7993
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Country | US
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Telephone | 850-526-2412
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Fax | 850-482-1394
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Provider Business Mailing Address
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Address Line | 32 TRILLIUM CIR APT 202
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City | DOTHAN
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State | AL
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Zip | 36301-5631
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Country | US
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Telephone | 207-217-2945
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 10537
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License Number State | FL
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