| NPI | 1750892154 |
|---|---|
| Former Name | GRACE GOODWIN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 277.001314) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209.016583) |
| Enumeration Date | 2017-10-12 |
| Last Update Date | 2023-06-22 |