| NPI | 1881149219 |
|---|---|
| Former Name | STEPHANIE GOODWIN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AZ 235816) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 209014685) |
| Enumeration Date | 2016-08-15 |
| Last Update Date | 2023-10-30 |