Provider Demographics
NPI:1497727192
Name:LALOUDAKIS, DESPINA (NP)
Entity Type:Individual
Prefix:
First Name:DESPINA
Middle Name:
Last Name:LALOUDAKIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4530 E MUIRWOOD DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-7639
Mailing Address - Country:US
Mailing Address - Phone:480-961-2303
Mailing Address - Fax:480-961-0419
Practice Address - Street 1:4530 E MUIRWOOD DR
Practice Address - Street 2:SUITE 105
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-7639
Practice Address - Country:US
Practice Address - Phone:480-961-2303
Practice Address - Fax:480-961-0419
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN089214363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ2Z1482OtherHEALTHNET
AZ504086Medicaid
AZQ20586Medicare UPIN
AZP00138506Medicare PIN
AZ504086Medicaid