Basic Information
| Provider Information | |||||||||
| NPI: | 1639655434 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HODGMAN | ||||||||
| FirstName: | SAMANTHA | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | |||||||||
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| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ALARCON | ||||||||
| OtherFirstName: | SAMANTHA | ||||||||
| OtherMiddleName: | LYNN | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1017 JANA LN | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537047865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6082397215 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5109 WORLD DAIRY DR | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537183807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6082420220 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2018 | ||||||||
| LastUpdateDate: | 07/14/2018 | ||||||||
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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 | 164W00000X | 320727 | WI | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.