Individual
MS. BEATRICE LEE GODBOULDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
821 N NELLIS BLVD, LAS VEGAS, NV 89110-5339
(702) 438-4003
(702) 438-0555
Mailing address
PO BOX 98978, LAS VEGAS, NV 89193-8978
(702) 216-3346
(702) 671-6883
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
PA12936
CA
363A00000X
Physician Assistant
PA12936
CA
363AM0700X
Medical Physician Assistant
Primary
PA1710
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1457406241
—
NV
Enumeration date
01/24/2007
Last updated
03/17/2017
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