Basic Information
| Provider Information | |||||||||
| NPI: | 1538474432 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HODAKIEVIC | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | DAWN | ||||||||
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| Credential: | CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 307 W MAIN ST | ||||||||
| Address2: | STE. C | ||||||||
| City: | KENT | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442402400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306773628 | ||||||||
| FaxNumber: | 3306773626 | ||||||||
| Practice Location | |||||||||
| Address1: | 307 W MAIN ST | ||||||||
| Address2: | STE. C | ||||||||
| City: | KENT | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442402400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306773628 | ||||||||
| FaxNumber: | 3306773626 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2010 | ||||||||
| LastUpdateDate: | 01/18/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | COA11651NP | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 1841239274 | 01 | OH | PARTNERS PHYSICIAN GROUP TYPE 2 NPI # | OTHER | 2551671 | 01 | OH | PARTNERS PHYSICIAN GROUP MEDICAID GROUP # | OTHER | 9338635 | 01 | OH | PARTNERS PHYSICIAN GROUP MEDICARE GROUP # | OTHER | 0050283 | 05 | OH | MEDICAID |