Provider Demographics
NPI:1508402207
Name:GODWIN, MONICA C (RN)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:C
Last Name:GODWIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10725 CLARK RD SE
Mailing Address - Street 2:
Mailing Address - City:YELM
Mailing Address - State:WA
Mailing Address - Zip Code:98597-9524
Mailing Address - Country:US
Mailing Address - Phone:915-539-9871
Mailing Address - Fax:
Practice Address - Street 1:12180 PARK AVE S
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98447-0014
Practice Address - Country:US
Practice Address - Phone:253-535-7672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-18
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60478347163W00000X
WAAP61194658363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse