Provider Demographics
NPI:1992006126
Name:GODFREY, GAYLE ELIZABETH (RNBC)
Entity Type:Individual
Prefix:MS
First Name:GAYLE
Middle Name:ELIZABETH
Last Name:GODFREY
Suffix:
Gender:F
Credentials:RNBC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6504 WARREN AVE S
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-1247
Mailing Address - Country:US
Mailing Address - Phone:651-403-5005
Mailing Address - Fax:651-224-5754
Practice Address - Street 1:408 SAINT PETER AVE.
Practice Address - Street 2:429
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102
Practice Address - Country:US
Practice Address - Phone:651-224-0614
Practice Address - Fax:651-224-5754
Is Sole Proprietor?:No
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 105954-2163WG0600X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WG0600XNursing Service ProvidersRegistered NurseGerontology