Individual
IMELDA GODBOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
420 W 4TH ST, SUITE 100-A, MISHAWAKA, IN 46544-1948
(574) 252-0317
(574) 472-3694
Mailing address
6864 FIR RD, BREMEN, IN 46506-9718
(574) 342-6015
Taxonomy
Speciality
Code
Description
License number
State
163WC0400X
Case Management Registered Nurse
Primary
28170434A
IN
Other
Enumeration date
10/14/2008
Last updated
10/14/2008
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