Provider Demographics
NPI:1891449484
Name:GOODWIN-ALSTON, JANICE
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:GOODWIN-ALSTON
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 1:10607 BLACK FOX CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-2613
Mailing Address - Country:US
Mailing Address - Phone:301-633-4692
Mailing Address - Fax:
Practice Address - Street 1:3115 24TH ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-2705
Practice Address - Country:US
Practice Address - Phone:202-889-7947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant