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Individual

DR. AMY NICOLE GOODWINE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
AU.D.

Contact information

Practice address
3986 FETTLER PARK DR, DUMFRIES, VA 22025-1997
(703) 221-8307
(703) 221-8548
Mailing address
3986 FETTLER PARK DR, DUMFRIES, VA 22025-1997
(703) 221-8307
(703) 221-8548

Taxonomy

Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
2201000658
VA
237600000X
Audiologist-Hearing Aid Fitter
2101001172
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
010244919
VA
01
392788YGFF
MEDICARE
VA
Enumeration date
04/14/2006
Last updated
11/02/2022
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