Healthcare Provider Details

I. General information

NPI: 1932444304
Provider Name (Legal Business Name): HEATHER MARIE HODNETT IGBINOVIA ANP-BC, GNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. HEATHER MARIE HODNETT

II. Dates (important events)

Enumeration Date: 12/11/2012
Last Update Date: 05/04/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 E UNIVERSITY DR
TEMPE AZ
85281-1091
US

IV. Provider business mailing address

1144 65TH ST STE F
OAKLAND CA
94608-1053
US

V. Phone/Fax

Practice location:
  • Phone: 623-624-8280
  • Fax: 602-835-0192
Mailing address:
  • Phone: 510-929-1400
  • Fax: 510-929-1414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP4825
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberAP4825
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: