Provider Demographics
NPI:1790433399
Name:GODINA, ALEXANDRA NICOLE (RN)
Entity type:Individual
Prefix:MRS
First Name:ALEXANDRA
Middle Name:NICOLE
Last Name:GODINA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5969 N HARTFORD CT
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67219-2255
Mailing Address - Country:US
Mailing Address - Phone:316-305-1518
Mailing Address - Fax:
Practice Address - Street 1:5969 N HARTFORD CT
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:KS
Practice Address - Zip Code:67219-2255
Practice Address - Country:US
Practice Address - Phone:316-305-1518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-13
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS137313163W00000X
KS53-82643-042363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatalGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSNONEMedicaid