MEDICARE: BONNIE SUE GOODWIN FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	200623	NC

General Provider Information

NPI Number	:	1700801099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BONNIE SUE GOODWIN FNP

Provider Business Mailing Address
First Line	:	191 TREX RD
Second Line	:
City	:	ROCKWELL
State	:	NC
Zip	:	28138-9643
Country	:	US
Telephone Number	:	980-258-9434
Fax Number	:

Provider Business Practice Location Address
First Line	:	5225 POPLAR TENT RD
Second Line	:	MINUTECLINIC DIAGNOSTIC OF NORTH CAROLINA
City	:	CONCORD
State	:	NC
Zip	:	28027-7757
Country	:	US
Telephone Number	:	866-389-2727
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	03/28/2022

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