Provider Demographics
NPI:1306001300
Name:GODSEY, CYNTHIA ANNE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ANNE
Last Name:GODSEY
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 S MAIN ST STE 500
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-3406
Mailing Address - Country:US
Mailing Address - Phone:801-517-6991
Mailing Address - Fax:
Practice Address - Street 1:405 S MAIN ST STE 500
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-3406
Practice Address - Country:US
Practice Address - Phone:801-517-6991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-20
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1906614405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily