Provider Demographics
NPI:1790426526
Name:GOODWIN, LAUREN NICOLE (NP)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:NICOLE
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:LAUREN
Other - Middle Name:NICOLE
Other - Last Name:PRACHAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 100174
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29202-3174
Mailing Address - Country:US
Mailing Address - Phone:864-512-5667
Mailing Address - Fax:864-512-6746
Practice Address - Street 1:2000 E GREENVILLE ST STE 1100
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-1714
Practice Address - Country:US
Practice Address - Phone:864-512-5667
Practice Address - Fax:864-512-6746
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25775363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily