Provider Demographics
NPI:1730274093
Name:GODIN, DAVID W (CRNA)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:W
Last Name:GODIN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PRENTISS HILL RD
Mailing Address - Street 2:
Mailing Address - City:HUBBARDSTON
Mailing Address - State:MA
Mailing Address - Zip Code:01452-1414
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 PRENTISS HILL RD
Practice Address - Street 2:
Practice Address - City:HUBBARDSTON
Practice Address - State:MA
Practice Address - Zip Code:01452-1414
Practice Address - Country:US
Practice Address - Phone:978-928-4825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN147736367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110106612AMedicaid
MANA018301Medicare PIN