Healthcare Provider Details

I. General information

NPI: 1992538458
Provider Name (Legal Business Name): HANNA ESTHAY GOODWIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2024
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 DR MICHAEL DEBAKEY DR
LAKE CHARLES LA
70601-5726
US

IV. Provider business mailing address

1101 KENT HILL RD
LAKE CHARLES LA
70605-0610
US

V. Phone/Fax

Practice location:
  • Phone: 337-436-1370
  • Fax: 337-436-1621
Mailing address:
  • Phone: 337-329-5747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number206384
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number206384
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: