Healthcare Provider Details

I. General information

NPI: 1952261489
Provider Name (Legal Business Name): MARCY GODDARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2025
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 N QUINCY AVE
OTTUMWA IA
52501-3810
US

IV. Provider business mailing address

1020 N QUINCY AVE STE 1
OTTUMWA IA
52501-3810
US

V. Phone/Fax

Practice location:
  • Phone: 641-683-4300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number111411
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: