Provider Demographics
NPI:1568056406
Name:GOODWIN, TUNESE (PROTHETIC SPECIALIST)
Entity Type:Individual
Prefix:
First Name:TUNESE
Middle Name:
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:PROTHETIC SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6024 N 107TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-1044
Mailing Address - Country:US
Mailing Address - Phone:402-598-4443
Mailing Address - Fax:
Practice Address - Street 1:798 FORT CROOK RD S
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-2964
Practice Address - Country:US
Practice Address - Phone:402-598-4443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
No335E00000XSuppliersProsthetic/Orthotic Supplier