Provider Demographics
NPI:1366978496
Name:GODWIN, ELSIE (CRNA)
Entity type:Individual
Prefix:
First Name:ELSIE
Middle Name:
Last Name:GODWIN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ELSIE
Other - Middle Name:
Other - Last Name:EVAKISE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:251 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21550-1375
Mailing Address - Country:US
Mailing Address - Phone:301-533-4567
Mailing Address - Fax:
Practice Address - Street 1:251 N 4TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550-1375
Practice Address - Country:US
Practice Address - Phone:301-533-4567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-10
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR17533600163W00000X
TX910636163W00000X
NY694178163W00000X
TXAP133360163W00000X, 367500000X
MDR232256367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX371226701Medicaid
TX8GV402OtherBCBS