Individual
THERESA M. GODSHALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1200 S CEDAR CREST BLVD, ALLENTOWN, PA 18103-6202
(610) 402-9099
(610) 402-9029
Mailing address
1245 S CEDAR CREST BLVD, SUITE #301, ALLENTOWN, PA 18103-6258
(610) 402-9099
(610) 402-9029
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN241001L
PA
367500000X
Certified Registered Nurse Anesthetist
Primary
039848
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03222701
CAPITAL ADVANTAGE
PA
05
—
1027820420001
—
PA
01
—
11783674
CAQH
PA
01
—
1368657
KHP CENTRAL
PA
01
—
1544545
GATEWAY
PA
01
—
206043000
INDEP. BLUE CROSS
PA
01
—
76023
GEISINGER
PA
01
—
9417489
AETNA
PA
Enumeration date
09/16/2005
Last updated
03/25/2013
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