Provider Demographics
NPI:1194614800
Name:GODFREY, MARIE ANN
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:ANN
Last Name:GODFREY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-3120
Mailing Address - Country:US
Mailing Address - Phone:308-660-7028
Mailing Address - Fax:308-660-7028
Practice Address - Street 1:613 E 8TH ST
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-3120
Practice Address - Country:US
Practice Address - Phone:308-660-7028
Practice Address - Fax:308-660-7028
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
NE103TA0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No374U00000XNursing Service Related ProvidersHome Health Aide