Provider Demographics
NPI:1891772406
Name:GODFREY, TERESA MERCER (RN)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:MERCER
Last Name:GODFREY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COMDT (CG-1122), U.S. COAST GUARD
Mailing Address - Street 2:2100 2ND STREET SW, SUITE 5314
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20593-0001
Mailing Address - Country:US
Mailing Address - Phone:252-335-6605
Mailing Address - Fax:252-334-5420
Practice Address - Street 1:WEEKSVILLE ROAD
Practice Address - Street 2:BUILDING 128 U.S. COAST GUARD SUPPORT CENTER
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909
Practice Address - Country:US
Practice Address - Phone:252-335-6605
Practice Address - Fax:252-334-5420
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC068797163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice