Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 4704283133 | MI |
NPI | 1063818326 |
---|---|
Provider Name | Laura Goodwin |
First Address | Southfield, MI 48033-3849 |
Second Address | Dearborn, MI 48124-4082 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2014 |
Last Update Date | 22/10/2020 |