Healthcare Provider Details

I. General information

NPI: 1831357904
Provider Name (Legal Business Name): JENNIFER B GODRICH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2460 CURTIS ELLIS DR
ROCKY MOUNT NC
27804-2237
US

IV. Provider business mailing address

2460 CURTIS ELLIS DR
ROCKY MOUNT NC
27804-2237
US

V. Phone/Fax

Practice location:
  • Phone: 252-443-8847
  • Fax: 252-443-8087
Mailing address:
  • Phone: 252-443-8847
  • Fax: 252-443-8087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number181339
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: