Provider Demographics
NPI:1013133230
Name:GOODWIN, EILEEN LORETTA (LPN)
Entity Type:Individual
Prefix:MISS
First Name:EILEEN
Middle Name:LORETTA
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 1:200 RIVERSIDE DR
Mailing Address - Street 2:APT# 408
Mailing Address - City:MILLVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08332-6724
Mailing Address - Country:US
Mailing Address - Phone:856-327-6530
Mailing Address - Fax:
Practice Address - Street 1:200 RIVERSIDE DR
Practice Address - Street 2:APT# 408
Practice Address - City:MILLVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08332-6724
Practice Address - Country:US
Practice Address - Phone:856-327-6530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNP33610164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse