Provider Demographics
NPI:1073717377
Name:GODFREY, KATHLEEN (RN)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:
Last Name:GODFREY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 PILGRIM ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:MA
Mailing Address - Zip Code:01254-5029
Mailing Address - Country:US
Mailing Address - Phone:413-281-5351
Mailing Address - Fax:
Practice Address - Street 1:10 PILGRIM ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:MA
Practice Address - Zip Code:01254-5029
Practice Address - Country:US
Practice Address - Phone:413-281-5351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA201317163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse