Healthcare Provider Details

I. General information

NPI: 1508347030
Provider Name (Legal Business Name): LAUREN MICHELLE GODBY PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. LAUREN MICHELLE GERL

II. Dates (important events)

Enumeration Date: 08/23/2018
Last Update Date: 08/18/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8081 INNOVATION PARK DR STE 765
FAIRFAX VA
22031-4867
US

IV. Provider business mailing address

814 N EDGEWOOD ST APT 1A
ARLINGTON VA
22201-1971
US

V. Phone/Fax

Practice location:
  • Phone: 571-472-1717
  • Fax: 571-472-1718
Mailing address:
  • Phone: 540-793-2954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number0024176584
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: