Individual
BETSY R GOODWIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
110 E ROUTT, PUEBLO, CO 81004
(719) 543-8711
(719) 543-5340
Mailing address
1925 E ORMAN AVE, STE 440, PUEBLO, CO 81004-3551
(719) 557-4744
(719) 557-4770
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
600
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07060007
—
CO
Enumeration date
08/02/2006
Last updated
03/10/2017
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