Individual
FARRELL GODBOUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
1950 W ROOSEVELT RD, CHICAGO, IL 60608-1245
(312) 433-3100
Mailing address
950 E 61ST ST, SUITE 207, CHICAGO, IL 60637-2623
(203) 980-3553
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209.009305
IL
Other
Enumeration date
04/24/2009
Last updated
02/08/2013
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