Organization
GODDARD MEDICAL SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SEAN GODDARD NP (OWNER)
(812) 226-9600
Entity
Organization
Contact information
Practice address
9025 COLDWATER RD STE 200, FORT WAYNE, IN 46825-2097
(260) 459-9225
(608) 001-5122
Mailing address
9025 COLDWATER RD STE 200, FORT WAYNE, IN 46825-2097
(260) 459-9225
(608) 001-5122
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
71008436A
STATE LICENSE
IN
Enumeration date
01/15/2020
Last updated
02/21/2024
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