Provider Demographics
NPI:1205888799
Name:GODI, PATRICIA ELIZABETH (CPNP-PC)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ELIZABETH
Last Name:GODI
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:MRS
Other - First Name:PATRICIA
Other - Middle Name:ELIZABETH
Other - Last Name:LUTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP
Mailing Address - Street 1:919 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-5021
Mailing Address - Country:US
Mailing Address - Phone:214-644-0280
Mailing Address - Fax:214-644-0294
Practice Address - Street 1:919 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-5021
Practice Address - Country:US
Practice Address - Phone:214-644-0280
Practice Address - Fax:214-644-0294
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX96644363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX129982807Medicaid
TX677248OtherRN LICENSE #