Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | NPPA041708 | PA |
NPI | 1083232557 |
---|---|
Provider Name | Riane Goodwin |
First Address | Philadelphia, PA 19107-4251 |
Second Address | Philadelphia, PA 19104-4319 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2020 |
Last Update Date | 10/07/2020 |