Basic Information
| Provider Information | |||||||||
| NPI: | 1558523639 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GODFREY | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | ARTHUR | ||||||||
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| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 315 W COTA ST APT B | ||||||||
| Address2: | |||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931017051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8059625859 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 580 MOHAWK DR | ||||||||
| Address2: | BASELINE MEDICAL OFFICES | ||||||||
| City: | BOULDER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 803033712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036141493 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2008 | ||||||||
| LastUpdateDate: | 06/30/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 45858 | CO | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.