Healthcare Provider Details

I. General information

NPI: 1548929235
Provider Name (Legal Business Name): JENNIFER LYNN GODEK APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2021
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 TSIENNETO RD STE 200
DERRY NH
03038-1559
US

IV. Provider business mailing address

15 TSIENNETO RD STE 200
DERRY NH
03038-1559
US

V. Phone/Fax

Practice location:
  • Phone: 603-552-3309
  • Fax: 603-965-4177
Mailing address:
  • Phone: 603-552-3309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number065403-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: