Provider Demographics
NPI:1376187625
Name:GOODWIN, WYVONEE NORSTUN
Entity type:Individual
Prefix:
First Name:WYVONEE
Middle Name:NORSTUN
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 NW AVENUE M APT 216
Mailing Address - Street 2:
Mailing Address - City:ANDREWS
Mailing Address - State:TX
Mailing Address - Zip Code:79714-3524
Mailing Address - Country:US
Mailing Address - Phone:903-276-6354
Mailing Address - Fax:
Practice Address - Street 1:200 NW AVENUE M APT 216
Practice Address - Street 2:
Practice Address - City:ANDREWS
Practice Address - State:TX
Practice Address - Zip Code:79714-3524
Practice Address - Country:US
Practice Address - Phone:903-276-6354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-30
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX755472163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse