Provider Demographics
NPI:1275319840
Name:GODFRYD, MARY AVERY (CERTIFIED DOULA)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:AVERY
Last Name:GODFRYD
Suffix:
Gender:F
Credentials:CERTIFIED DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 REDWOOD LN
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-1014
Mailing Address - Country:US
Mailing Address - Phone:530-902-0366
Mailing Address - Fax:
Practice Address - Street 1:1400 REDWOOD LN
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-1014
Practice Address - Country:US
Practice Address - Phone:530-902-0366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula