Provider Demographics
NPI:1730786484
Name:GODFREY, GILLIE LORRAINE
Entity type:Individual
Prefix:
First Name:GILLIE
Middle Name:LORRAINE
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 1:167 NEELY ST
Mailing Address - Street 2:
Mailing Address - City:WHITE SULPHUR SPRINGS
Mailing Address - State:WV
Mailing Address - Zip Code:24986-3084
Mailing Address - Country:US
Mailing Address - Phone:304-536-2389
Mailing Address - Fax:
Practice Address - Street 1:167 NEELY ST
Practice Address - Street 2:
Practice Address - City:WHITE SULPHUR SPRINGS
Practice Address - State:WV
Practice Address - Zip Code:24986-3084
Practice Address - Country:US
Practice Address - Phone:304-536-2389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-06
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant