Individual
GABRIELLE GODFREY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1019 NICKLAUS DR, SUFFOLK, VA 23435-4102
(757) 537-9010
Mailing address
3575 BRIDGE RD, SUITE 8 PMB 208, SUFFOLK, VA 23435
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
A60366253
VA
Other
Enumeration date
11/13/2019
Last updated
11/13/2019
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