Provider Demographics
NPI:1023191483
Name:GOODWIN, KATHLEEN MARINO (CNM)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:MARINO
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5492 RINGER RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-1570
Mailing Address - Country:US
Mailing Address - Phone:314-471-1736
Mailing Address - Fax:314-454-5167
Practice Address - Street 1:1 BARNES JEWISH HOSPITAL PLZ
Practice Address - Street 2:OLD MATERNITY BUILDING
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1003
Practice Address - Country:US
Practice Address - Phone:314-454-7882
Practice Address - Fax:314-454-5167
Is Sole Proprietor?:No
Enumeration Date:2006-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO054553367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife