Provider Demographics
NPI:1033102579
Name:GODARD, KAREN L (RNC, CPNP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:L
Last Name:GODARD
Suffix:
Gender:F
Credentials:RNC, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 UNIVERSITY DR
Mailing Address - Street 2:SN 128
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83725-0002
Mailing Address - Country:US
Mailing Address - Phone:208-426-3628
Mailing Address - Fax:
Practice Address - Street 1:1305 3RD ST S
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-3903
Practice Address - Country:US
Practice Address - Phone:208-475-5700
Practice Address - Fax:208-475-5710
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-822A; N36983363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS82718Medicare UPIN