Provider Demographics
NPI:1891744371
Name:GOODWIN, NANCY ELLEN (LAC)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:ELLEN
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 GREYWOLF RD
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-9483
Mailing Address - Country:US
Mailing Address - Phone:360-355-5989
Mailing Address - Fax:
Practice Address - Street 1:61 GREYWOLF RD
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-9483
Practice Address - Country:US
Practice Address - Phone:360-355-5989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2021-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC 00000501171100000X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist