Basic Information
Provider Information
NPI: 1215469648
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HODGES-WILLS
FirstName: TONI
MiddleName: DENISE
NamePrefix:  
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8906 SPANISH RIDGE AVE STE 202
Address2:  
City: LAS VEGAS
State: NV
PostalCode: 891481319
CountryCode: US
TelephoneNumber: 7023303102
FaxNumber: 7029124994
Practice Location
Address1: 653 N TOWN CENTER DR STE 317
Address2:  
City: LAS VEGAS
State: NV
PostalCode: 891440504
CountryCode: US
TelephoneNumber: 0238229007
FaxNumber: 7023821980
Other Information
ProviderEnumerationDate: 04/03/2017
LastUpdateDate: 05/14/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/14/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000XDO2900NVY Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 

No ID Information.


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