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Individual
MRS. AMANDA M GOODWIN
Active
Individual
MRS. AMANDA M GOODWIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
5601004842
MI
363A00000X
Physician Assistant
Primary
AG004842
MI
363AM0700X
Medical Physician Assistant
5601004842
MI
363AS0400X
Surgical Physician Assistant
5601004842
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200G311050
BCBS GROUP
—
Enumeration date
08/07/2006
Last updated
03/26/2021
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