Provider Demographics
NPI:1821213372
Name:GOODWIN, CONCEPCION (RN, RDH)
Entity type:Individual
Prefix:
First Name:CONCEPCION
Middle Name:
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:RN, RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 MANZI WAY
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:MA
Mailing Address - Zip Code:01516-2564
Mailing Address - Country:US
Mailing Address - Phone:508-476-2710
Mailing Address - Fax:
Practice Address - Street 1:9 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:CENTRAL FALLS
Practice Address - State:RI
Practice Address - Zip Code:02863-2005
Practice Address - Country:US
Practice Address - Phone:401-724-7110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN41604163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse