Healthcare Provider Details

I. General information

NPI: 1043043946
Provider Name (Legal Business Name): LAURA STANTON GODFREY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2024
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490A W ZIA RD
SANTA FE NM
87505-6996
US

IV. Provider business mailing address

490A W ZIA RD
SANTA FE NM
87505-6996
US

V. Phone/Fax

Practice location:
  • Phone: 505-913-3450
  • Fax:
Mailing address:
  • Phone: 505-913-3450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN-86049
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: