Provider Demographics
NPI:1306841259
Name:GOODWIN, NINA BLEUE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:NINA
Middle Name:BLEUE
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:NINA
Other - Middle Name:BLEUE
Other - Last Name:CHAPOTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:670 9TH ST STE 203
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-6249
Mailing Address - Country:US
Mailing Address - Phone:707-826-8633
Mailing Address - Fax:707-826-8638
Practice Address - Street 1:1644 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:MCKINLEYVILLE
Practice Address - State:CA
Practice Address - Zip Code:95519-4342
Practice Address - Country:US
Practice Address - Phone:707-839-3068
Practice Address - Fax:707-839-3827
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12710363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner