1003803446 NPI number — JANICE ELAINE HODGE CRNP

Table of content: JANICE ELAINE HODGE CRNP (NPI 1003803446)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003803446 NPI number — JANICE ELAINE HODGE CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HODGE
Provider First Name:
JANICE
Provider Middle Name:
ELAINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003803446
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9509 WHETSTONE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTGOMRY VILLAGE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20886-3109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-926-4627
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15825 SHADY GROVE RD
Provider Second Line Business Practice Location Address:
STE 140
Provider Business Practice Location Address City Name:
ROCKVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20850-4008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-869-9776
Provider Business Practice Location Address Fax Number:
301-216-2592
Provider Enumeration Date:
09/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  RO87926 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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