Basic Information
| Provider Information | |||||||||
| NPI: | 1497889315 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HODOVAN | ||||||||
| FirstName: | ADAM | ||||||||
| MiddleName: | S. | ||||||||
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| Credential: | APRN-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 194 WILDWOOD LN | ||||||||
| Address2: | |||||||||
| City: | FLAT TOP | ||||||||
| State: | WV | ||||||||
| PostalCode: | 258419730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3047873452 | ||||||||
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| Practice Location | |||||||||
| Address1: | 122 12TH STREET EXT | ||||||||
| Address2: | PRINCETON COMMUNITY HOSPITAL | ||||||||
| City: | PRINCETON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 247402352 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044877275 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2007 | ||||||||
| LastUpdateDate: | 04/04/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 58789 | WV | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | 58789 | WV | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.