Provider Demographics
NPI:1538592134
Name:GOODWIN, MEREDITH PETTIT (CNP)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:PETTIT
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:LEIGH
Other - Last Name:PETTIT, EVENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2005 DE LA CRUZ BLVD STE 271
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050-3031
Mailing Address - Country:US
Mailing Address - Phone:408-313-4166
Mailing Address - Fax:408-986-0354
Practice Address - Street 1:2005 DE LA CRUZ BLVD STE 271
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-3031
Practice Address - Country:US
Practice Address - Phone:408-313-4166
Practice Address - Fax:408-986-0354
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95014630363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily