Provider Demographics
NPI:1568804615
Name:GODDARD, MICHELLE NICOLE (NP)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:NICOLE
Last Name:GODDARD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 BENVENITO PL
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-2972
Mailing Address - Country:US
Mailing Address - Phone:530-701-3011
Mailing Address - Fax:
Practice Address - Street 1:5821 JAMESON CT
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-0890
Practice Address - Country:US
Practice Address - Phone:916-486-0411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21997363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology