Basic Information
| Provider Information | |||||||||
| NPI: | 1578894325 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HODGE | ||||||||
| FirstName: | CANDRA | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 53 SUTHERLAND AVE | ||||||||
| Address2: | |||||||||
| City: | NAPOLEON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435459274 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4199664827 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 600 FREEDOM DR | ||||||||
| Address2: | |||||||||
| City: | NAPOLEON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435459038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4195991660 | ||||||||
| FaxNumber: | 4195928336 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2010 | ||||||||
| LastUpdateDate: | 01/19/2010 | ||||||||
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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 | 163W00000X | RN355478 | OH | Y | Nursing Service Providers | Registered Nurse |
No ID Information.