Healthcare Provider Details

I. General information

NPI: 1093482531
Provider Name (Legal Business Name): MARTA GODLEWSKA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2021
Last Update Date: 08/24/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 HUNTS BROOK RD
QUAKER HILL CT
06375-1009
US

IV. Provider business mailing address

78 HUNTS BROOK RD
QUAKER HILL CT
06375-1000
US

V. Phone/Fax

Practice location:
  • Phone: 860-442-9454
  • Fax:
Mailing address:
  • Phone: 860-442-9454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number168346
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: