Marializa Godoy Padilla Jackson, APRN, MSN,PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

4704188063 Issued in MI

Practice address

51999 Copper Creek CT
Chesterfield, MI 48047-5968

Phone

(586) 275-9658

NPI assigned

May 10, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Maria Liza Godoy Laureta Former name

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mi Pacs 2 PC

  • Hospitalist Physician
  • Northville, MI
  • NPI 1205418357
  Medicare reassignment NPD
• Michigan Post-Acute Medical Services 1 PC

  • Hospitalist Physician
  • Brighton, MI
  • NPI 1669901567
  Medicare reassignment NPD
• CS Pacs 3 Midwest LLC

  • Hospitalist Physician
  • Dayton, OH
  • NPI 1972368785

  MI

  Medicare reassignment NPD
• NV Pacs 2 LLC

  • Hospitalist Physician
  • Las Vegas, NV
  • NPI 1427534809
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1683676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717372800000",
    "number": "1306536545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "51999 COPPER CREEK CT",
            "city": "CHESTERFIELD",
            "state": "MI",
            "postal_code": "480475968",
            "telephone_number": "586-275-9658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "51999 COPPER CREEK CT",
            "city": "CHESTERFIELD",
            "state": "MI",
            "postal_code": "480475968",
            "telephone_number": "586-275-9658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "MARIALIZA GODOY",
        "middle_name": "PADILLA",
        "credential": "APRN, MSN,PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-05-10",
        "last_updated": "2024-06-03",
        "certification_date": "2024-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MI",
            "license": "4704188063",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARIA LIZA",
            "last_name": "LAURETA",
            "middle_name": "GODOY",
            "credential": "BSN, RN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Evelyn Jackson
• Jordan Jackson
• Kellie Michelle Jackson
• Lisa Jackson
• Macy Jackson
• Marlene M Jackson, LPN
• Zakara Angelique Jackson
• Nitin Jain, M.D.
• James F. Pradko, MD PC
• Kieona James-Reed

• Psychiatric/Mental Health Nurse Practitioner in Chesterfield, MI
• Providers in Chesterfield, MI by specialty
• Psychiatric/Mental Health Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.