MEDICARE: HALIMA JOSINA GOODWIN DNP, CPNP-PC, PMHNP

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	363LP0200X	Pediatric Nurse Practitioner	RN968478	DC
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	85401	TX

General Provider Information

NPI Number	:	1952630071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HALIMA JOSINA GOODWIN DNP, CPNP-PC, PMHNP

Provider Business Mailing Address
First Line	:	5203 JUAN TABO BLVD NE STE 2B
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-2691
Country	:	US
Telephone Number	:	505-550-1011
Fax Number	:	505-207-5377

Provider Business Practice Location Address
First Line	:	5203 JUAN TABO BLVD NE STE 2B
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-2691
Country	:	US
Telephone Number	:	505-550-1011
Fax Number	:	505-207-5377

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

Provider Enumeration Date	:	12/19/2009
Last Update Date	:	04/20/2023

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