Provider Demographics
NPI:1720869779
Name:GOODWIN, JANINE (RN)
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:
Last Name:GOODWIN
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 1:6705 COVERED BRIDGE DR UNIT 33
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78736-3315
Mailing Address - Country:US
Mailing Address - Phone:512-636-1069
Mailing Address - Fax:
Practice Address - Street 1:3101 S AUSTIN AVE
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-7541
Practice Address - Country:US
Practice Address - Phone:877-500-9151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-06
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX705870163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent