Provider Demographics
NPI:1326754508
Name:GOODWIN, ANNETTE MICHELLE (FNP)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:MICHELLE
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 601843
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1843
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:105 HANES SQUARE CIR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-5514
Practice Address - Country:US
Practice Address - Phone:336-441-5569
Practice Address - Fax:336-771-1907
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2023-05-03
Deactivation Date:2023-01-31
Deactivation Code:
Reactivation Date:2023-02-15
Provider Licenses
StateLicense IDTaxonomies
NC139701363LF0000X
NCGOOD-EMVCE363LF0000X
NC5017618363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily