Provider Demographics
NPI:1487384566
Name:GOODNIGHT, MAKENNA ALYSON (AT)
Entity type:Individual
Prefix:
First Name:MAKENNA
Middle Name:ALYSON
Last Name:GOODNIGHT
Suffix:
Gender:F
Credentials:AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 SAVANNAH RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-3228
Mailing Address - Country:US
Mailing Address - Phone:302-943-4946
Mailing Address - Fax:
Practice Address - Street 1:907 SAVANNAH RD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-3228
Practice Address - Country:US
Practice Address - Phone:302-943-4946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer