Provider Demographics
NPI:1659475820
Name:GODMAIRE, ANDREE
Entity Type:Individual
Prefix:MS
First Name:ANDREE
Middle Name:
Last Name:GODMAIRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 METHODIST HILL RD
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03781-5418
Mailing Address - Country:US
Mailing Address - Phone:603-448-1059
Mailing Address - Fax:
Practice Address - Street 1:115 ETNA ROAD BUILDING 1
Practice Address - Street 2:SUITE 1
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766
Practice Address - Country:US
Practice Address - Phone:603-448-4251
Practice Address - Fax:603-448-4251
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHC20104 (BOC)225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30763212Medicaid
VT1012747Medicaid
NH12Y004995NH01OtherANTHEM BCBS