Provider Demographics
NPI:1962405480
Name:VODHI, GEORGETTE C (ANP-C)
Entity type:Individual
Prefix:MS
First Name:GEORGETTE
Middle Name:C
Last Name:VODHI
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
Other - First Name:GEORGETTE
Other - Middle Name:C
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:9201 E MOUNTAIN VIEW RD STE 220
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-5172
Mailing Address - Country:US
Mailing Address - Phone:877-506-3627
Mailing Address - Fax:877-506-4560
Practice Address - Street 1:9201 E MOUNTAIN VIEW RD STE 220
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5172
Practice Address - Country:US
Practice Address - Phone:877-506-3627
Practice Address - Fax:877-506-4560
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-30
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201050011NP305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR117264V62Medicare UPIN