Provider Demographics
NPI:1164202859
Name:GOODROW, MALINDA (LPN)
Entity Type:Individual
Prefix:
First Name:MALINDA
Middle Name:
Last Name:GOODROW
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1228 COLONIAL COMMONS CT
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29720-2215
Mailing Address - Country:US
Mailing Address - Phone:803-286-9948
Mailing Address - Fax:
Practice Address - Street 1:1228 COLONIAL COMMONS CT
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-2215
Practice Address - Country:US
Practice Address - Phone:803-286-9948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC44114164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse