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General NPI Number Information
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NPI Number | 1902624265
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Entity Type | Individual
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Provider Name | MARY GODINICH PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/26/2024
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Last Update Date | 01/09/2026
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Provider Practice Location Address
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Address Line | 11011 HEFNER POINTE DR STE A
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City | OKLAHOMA CITY
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State | OK
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Zip | 73120-5005
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Country | US
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Telephone | 405-479-8300
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Fax |
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Provider Business Mailing Address
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Address Line | 945 NE 16TH ST
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City | OKLAHOMA CITY
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State | OK
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Zip | 73104-4609
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Country | US
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Telephone | 405-623-7848
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5689
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License Number State | OK
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