Provider Demographics
NPI:1174976542
Name:GOODWIN, MARIE (MSN FNP-C)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:MSN FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BOYDTON
Mailing Address - State:VA
Mailing Address - Zip Code:23917-3415
Mailing Address - Country:US
Mailing Address - Phone:434-738-6420
Mailing Address - Fax:434-738-6054
Practice Address - Street 1:380 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BOYDTON
Practice Address - State:VA
Practice Address - Zip Code:23917-3415
Practice Address - Country:US
Practice Address - Phone:434-738-6420
Practice Address - Fax:434-738-6054
Is Sole Proprietor?:No
Enumeration Date:2016-07-20
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR0349979363LF0000X
VA0024173918363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily