Provider Demographics
NPI:1053737759
Name:GODMINTZ, JOANNE
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:GODMINTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 NE SERPENTINE PL
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-5229
Mailing Address - Country:US
Mailing Address - Phone:206-412-0220
Mailing Address - Fax:
Practice Address - Street 1:1840 NE SERPENTINE PL
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155-5229
Practice Address - Country:US
Practice Address - Phone:206-412-0220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-05
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00099988163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse