Provider Demographics
NPI:1689271330
Name:GOODWINE, INGA NYKOLE
Entity Type:Individual
Prefix:
First Name:INGA
Middle Name:NYKOLE
Last Name:GOODWINE
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 1:5 CHESTERTON DR
Mailing Address - Street 2:
Mailing Address - City:LANDENBERG
Mailing Address - State:PA
Mailing Address - Zip Code:19350-1162
Mailing Address - Country:US
Mailing Address - Phone:302-428-9388
Mailing Address - Fax:302-502-3813
Practice Address - Street 1:2911 LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-5226
Practice Address - Country:US
Practice Address - Phone:302-428-9388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment