MEDICARE: GODWIN N/A EFERIANA LVN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164X00000X	Licensed Vocational Nurse	227765	TX

General Provider Information

NPI Number	:	1518484674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GODWIN N/A EFERIANA LVN

Provider Business Mailing Address
First Line	:	5706 BLACK CANYON CT
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-8971
Country	:	US
Telephone Number	:	346-702-1604
Fax Number	:

Provider Business Practice Location Address
First Line	:	5706 BLACK CANYON CT
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-8971
Country	:	US
Telephone Number	:	346-702-1604
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2017
Last Update Date	:	07/21/2022

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