Provider Demographics
NPI:1518484674
Name:EFERIANA, GODWIN N/A (LVN)
Entity Type:Individual
Prefix:
First Name:GODWIN
Middle Name:N/A
Last Name:EFERIANA
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:N/A
Other - Middle Name:
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LVN
Mailing Address - Street 1:5706 BLACK CANYON CT
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-8971
Mailing Address - Country:US
Mailing Address - Phone:346-702-1604
Mailing Address - Fax:
Practice Address - Street 1:5706 BLACK CANYON CT
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-8971
Practice Address - Country:US
Practice Address - Phone:346-702-1604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX227765164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse