Healthcare Provider Details

I. General information

NPI: 1265351837
Provider Name (Legal Business Name): BRIGITTE M GODFREY NTP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4033 BRADEN LN SE
SALEM OR
97302-6524
US

IV. Provider business mailing address

4033 BRADEN LN SE
SALEM OR
97302-6524
US

V. Phone/Fax

Practice location:
  • Phone: 503-877-9758
  • Fax:
Mailing address:
  • Phone: 503-877-9758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: