Provider Demographics
NPI:1053931352
Name:GODFREY, IYISHA (RN)
Entity type:Individual
Prefix:
First Name:IYISHA
Middle Name:
Last Name:GODFREY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 E MAIN ST APT 440
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-2205
Mailing Address - Country:US
Mailing Address - Phone:216-801-3521
Mailing Address - Fax:
Practice Address - Street 1:324 E 244TH ST
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44123-1435
Practice Address - Country:US
Practice Address - Phone:216-801-3521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-16
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.413761163WH0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0500XNursing Service ProvidersRegistered NurseHemodialysis