Provider Demographics
NPI:1053058818
Name:GOODWIN, WINIFRED
Entity type:Individual
Prefix:
First Name:WINIFRED
Middle Name:
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 1:1 SKIPPER DR
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-3024
Mailing Address - Country:US
Mailing Address - Phone:985-626-5225
Mailing Address - Fax:985-626-5298
Practice Address - Street 1:1 SKIPPER DR
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-3024
Practice Address - Country:US
Practice Address - Phone:985-626-5225
Practice Address - Fax:985-626-5298
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-13
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA041220163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool