Provider Demographics
NPI:1508347030
Name:GODBY, LAUREN MICHELLE (PNP)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:MICHELLE
Last Name:GODBY
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:MS
Other - First Name:LAUREN
Other - Middle Name:MICHELLE
Other - Last Name:GERL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:814 N EDGEWOOD ST APT 1A
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-1971
Mailing Address - Country:US
Mailing Address - Phone:540-793-2954
Mailing Address - Fax:
Practice Address - Street 1:8081 INNOVATION PARK DR STE 765
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4867
Practice Address - Country:US
Practice Address - Phone:571-472-1717
Practice Address - Fax:571-472-1718
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024176584363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics