Provider Demographics
NPI:1578865093
Name:HODGE, MIRANDA LEIGH (CNP)
Entity type:Individual
Prefix:
First Name:MIRANDA
Middle Name:LEIGH
Last Name:HODGE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 MILLIKIN ST
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-3447
Mailing Address - Country:US
Mailing Address - Phone:513-746-5201
Mailing Address - Fax:
Practice Address - Street 1:3405 HAMILTON NEW LONDON RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-9459
Practice Address - Country:US
Practice Address - Phone:513-415-0888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-04
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4704374825363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care