Basic Information
| Provider Information | |||||||||
| NPI: | 1639555436 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HODGES | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | MSN, APRN, FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 875 OAK ST SE | ||||||||
| Address2: | STE 3040 | ||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973013906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034726161 | ||||||||
| FaxNumber: | 5034346290 | ||||||||
| Practice Location | |||||||||
| Address1: | 2435 NE CUMULUS AVE STE A | ||||||||
| Address2: | |||||||||
| City: | MCMINNVILLE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971288805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034726161 | ||||||||
| FaxNumber: | 5034346290 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2015 | ||||||||
| LastUpdateDate: | 11/22/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 201505345NP-PP | OR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 500690362 | 05 | OR | MEDICAID |