=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790433399
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALEXANDRA NICOLE GODINA RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2022
-----------------------------------------------------
Last Update Date | 11/09/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5969 N HARTFORD CT
-----------------------------------------------------
City | PARK CITY
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67219-2255
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-305-1518
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5969 N HARTFORD CT
-----------------------------------------------------
City | PARK CITY
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67219-2255
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-305-1518
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 137313
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LN0000X
-----------------------------------------------------
Taxonomy Name | Neonatal Nurse Practitioner
-----------------------------------------------------
License Number | 53-82643-042
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------