Provider Demographics
NPI:1477805141
Name:GOODWIN, ROBIN (LPN)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:GOODWIN
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 1:229 W 144TH ST
Mailing Address - Street 2:#54
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10030-1221
Mailing Address - Country:US
Mailing Address - Phone:646-262-9488
Mailing Address - Fax:
Practice Address - Street 1:229 WEST 144TH ST.
Practice Address - Street 2:54
Practice Address - City:NEWYORK
Practice Address - State:NY
Practice Address - Zip Code:10030
Practice Address - Country:US
Practice Address - Phone:646-262-9488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10305401164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse