| Doctor Name: | LAURA GOODWIN |
| NPI Number: | 1063818326 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | AGPCNP-BC |
| License Number: | 4704283133 |
| Business Practice Address: | 1203 S Wayne Rd Westland, MI - 481864362 |
| Business Phone Number: | 7347295780 |
| Business Fax Number: | |
| Mailing Address: | 1203 S Wayne Rd, WESTLAND |
| State: | MI |
| Postal Code: | 481864362 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 11/14/2014 |
| NPI Last Update Date: | 11/14/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP2300X |
| License Number: | 4704283133 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |