Provider Demographics
NPI:1235567975
Name:GODLEY, MAVIS ELIZABETH (APRN)
Entity Type:Individual
Prefix:MS
First Name:MAVIS
Middle Name:ELIZABETH
Last Name:GODLEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MAVIS
Other - Middle Name:ELIZABETH
Other - Last Name:MACNEIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:3514 MAIN ST
Mailing Address - Street 2:CVS HEALTH MINUTECLINIC
Mailing Address - City:COVENTRY
Mailing Address - State:CT
Mailing Address - Zip Code:06238-1551
Mailing Address - Country:US
Mailing Address - Phone:860-742-3543
Mailing Address - Fax:
Practice Address - Street 1:3514 MAIN ST
Practice Address - Street 2:CVS HEALTH MINUTECLINIC
Practice Address - City:COVENTRY
Practice Address - State:CT
Practice Address - Zip Code:06238-1551
Practice Address - Country:US
Practice Address - Phone:860-742-3543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-16
Last Update Date:2016-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5571363LF0000X
NYF337730363LF0000X
RIAPRN00475363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily