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General NPI Number Information
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NPI Number | 1922242718
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Entity Type | Individual
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Provider Name | FARRELL GODBOUT APN
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Gender | Female
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Dates
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Enumeration Date | 04/24/2009
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Last Update Date | 02/08/2013
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Provider Practice Location Address
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Address Line | 1950 W ROOSEVELT RD
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City | CHICAGO
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State | IL
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Zip | 60608-1245
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Country | US
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Telephone | 312-433-3100
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Fax |
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Provider Business Mailing Address
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Address Line | 950 E 61ST ST SUITE 207
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City | CHICAGO
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State | IL
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Zip | 60637-2623
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Country | US
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Telephone | 203-980-3553
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209.009305
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License Number State | IL
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