Provider Demographics
NPI:1316371776
Name:GODFREY, TERESA CHRISTINE (RN, BS, MS, FNP)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:CHRISTINE
Last Name:GODFREY
Suffix:
Gender:F
Credentials:RN, BS, MS, FNP
Other - Prefix:MISS
Other - First Name:TERESA
Other - Middle Name:CHRISTINE
Other - Last Name:KOSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:405 LAKE ZURICH RD
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-3141
Mailing Address - Country:US
Mailing Address - Phone:847-381-5599
Mailing Address - Fax:847-381-8042
Practice Address - Street 1:405 LAKE ZURICH RD
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-3141
Practice Address - Country:US
Practice Address - Phone:847-381-5599
Practice Address - Fax:847-381-8042
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-010114363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner