Basic Information
Provider Information
NPI: 1073818712
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HODDER
FirstName: BELINDA
MiddleName: E
NamePrefix: MRS.
NameSuffix:  
Credential: CNM
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3815 S. VAL VISTA DRIVE
Address2:  
City: GILBERT
State: AZ
PostalCode: 852977309
CountryCode: US
TelephoneNumber: 4807820993
FaxNumber: 8553298939
Practice Location
Address1: 3815 S VAL VISTA DRIVE
Address2:  
City: GILBERT
State: AZ
PostalCode: 852977309
CountryCode: US
TelephoneNumber: 4807820993
FaxNumber: 8553298939
Other Information
ProviderEnumerationDate: 01/11/2011
LastUpdateDate: 05/30/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367A00000XAP3908AZY Physician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife 

No ID Information.


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