Provider Demographics
NPI:1053750844
Name:GODWIN, BRUCE WAYNE (RN, COHN-S)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:WAYNE
Last Name:GODWIN
Suffix:
Gender:M
Credentials:RN, COHN-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 CENTRAL AVE.
Mailing Address - Street 2:NAVAL HEALTH CLINIC HAWAII
Mailing Address - City:JBPHH
Mailing Address - State:HI
Mailing Address - Zip Code:96860
Mailing Address - Country:US
Mailing Address - Phone:808-474-4242
Mailing Address - Fax:808-471-1437
Practice Address - Street 1:480 CENTRAL AVE.
Practice Address - Street 2:NAVAL HEALTH CLINIC HAWAII
Practice Address - City:JBPHH
Practice Address - State:HI
Practice Address - Zip Code:96860
Practice Address - Country:US
Practice Address - Phone:808-474-4242
Practice Address - Fax:808-471-1437
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-14
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN35705163WX0106X
CA520972163WX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0106XNursing Service ProvidersRegistered NurseOccupational Health