Healthcare Provider Details

I. General information

NPI: 1023522182
Provider Name (Legal Business Name): LAURETTE GODIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2017
Last Update Date: 11/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 POINT ROAD
ELMORE VT
05657
US

IV. Provider business mailing address

PO BOX 131
LOWELL VT
05847-0131
US

V. Phone/Fax

Practice location:
  • Phone: 802-888-5032
  • Fax:
Mailing address:
  • Phone: 802-673-8828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number026.0022181
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number026.0022181
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: