Provider Demographics
NPI:1609697051
Name:GOODWIN, MEISHA RENEE
Entity type:Individual
Prefix:
First Name:MEISHA
Middle Name:RENEE
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 1:4583 E 13 MILE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-1731
Mailing Address - Country:US
Mailing Address - Phone:586-441-6779
Mailing Address - Fax:
Practice Address - Street 1:607 SHELBY ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48226-3268
Practice Address - Country:US
Practice Address - Phone:586-441-6779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide