Provider Demographics
NPI:1790777449
Name:GODFREY, NANCY (MD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:
Last Name:GODFREY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6226 E SPRING ST
Mailing Address - Street 2:275
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-1423
Mailing Address - Country:US
Mailing Address - Phone:562-496-0546
Mailing Address - Fax:562-496-0946
Practice Address - Street 1:6226 E SPRING ST
Practice Address - Street 2:275
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-1423
Practice Address - Country:US
Practice Address - Phone:562-496-0546
Practice Address - Fax:562-496-0946
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG37982207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA91952Medicare UPIN
CAG37982Medicare ID - Type Unspecified