Individual
MS. LAURA SUE GOODWIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, PMHNP
Contact information
Practice address
4715 VIEWRIDGE AVE, STE 230, SAN DIEGO, CA 92123-1658
(800) 257-8715
(800) 819-1655
Mailing address
5312 CRAWFORD CT, FLOWER MOUND, TX 75028-1010
(469) 293-5296
(469) 293-5296
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
608881
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
175547202
—
TX
05
—
175547203
—
TX
01
—
8N9636
BLUE CROSS BLUE SHIELD
TX
Enumeration date
06/08/2006
Last updated
02/22/2010
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