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General NPI Number Information
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NPI Number | 1720194939
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Entity Type | Individual
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Provider Name | ANNA HAZEL GODDARD APRN, CPNP-PC
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Gender | Female
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 04/05/2016
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Provider Practice Location Address
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Address Line | 7 VAUXHALL ST CHILD & FAMILY AGENCY OF SECT, INC.
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City | NEW LONDON
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State | CT
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Zip | 06320-5711
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Country | US
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Telephone | 860-442-2797
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Fax | 860-701-3776
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Provider Business Mailing Address
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Address Line | 255 HEMPSTEAD ST
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City | NEW LONDON
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State | CT
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Zip | 06320-6204
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Country | US
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Telephone | 860-443-2896
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Fax | 860-442-5909
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 765853
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 3291
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 73362
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License Number State | CT
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