Provider Demographics
NPI:1467755090
Name:GOODWIN, JEUSHA COLEEN (CPM, LM)
Entity Type:Individual
Prefix:
First Name:JEUSHA
Middle Name:COLEEN
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1969 W DIVIDE CREEK ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-3451
Mailing Address - Country:US
Mailing Address - Phone:208-884-1223
Mailing Address - Fax:208-887-1935
Practice Address - Street 1:270 N LINDER RD
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-2437
Practice Address - Country:US
Practice Address - Phone:208-884-1223
Practice Address - Fax:208-887-1935
Is Sole Proprietor?:No
Enumeration Date:2010-12-21
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMID-14176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife