Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | C20104 (BOC) | NH |
NPI | 1659475820 |
---|---|
Provider Name | Ms. Andree Godmaire |
First Address | Plainfield, NH 03781-5418 |
Second Address | Lebanon, NH 03766 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2006 |
Last Update Date | 01/12/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1012747 | (05) | VT |
12Y004995NH01 | ANTHEM BCBS (01) | NH |
30763212 | (05) | NH |