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NPI Code Detail

MEDICARE: BONNIE SUE GOODWIN FNP

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
1363LF0000XFamily Nurse Practitioner200623NC

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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