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General NPI Number Information
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NPI Number | 1275589541
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Entity Type | Individual
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Provider Name | JANE W GODDARD NP
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Gender | Female
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 23 MANSFIELD AVE
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City | BURLINGTON
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State | VT
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Zip | 05401-3323
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Country | US
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Telephone | 802-863-6326
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Fax |
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Provider Business Mailing Address
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Address Line | 67 UNION ST
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City | WINOOSKI
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State | VT
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Zip | 05404-1948
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 1010010177
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License Number State | VT
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