Provider Demographics
NPI:1154008357
Name:GODINEZ, LOUANNIE THOMAS (NP)
Entity type:Individual
Prefix:DR
First Name:LOUANNIE
Middle Name:THOMAS
Last Name:GODINEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9827 N 95TH ST STE 105
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4591
Mailing Address - Country:US
Mailing Address - Phone:623-931-3028
Mailing Address - Fax:623-931-3029
Practice Address - Street 1:9150 W INDIAN SCHOOL RD STE 127
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-2388
Practice Address - Country:US
Practice Address - Phone:623-931-3028
Practice Address - Fax:623-931-3029
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-29
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ293711363LP0200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ132900Medicaid