Provider Demographics
NPI:1871620120
Name:HODGE, LADONNA C
Entity type:Individual
Prefix:
First Name:LADONNA
Middle Name:C
Last Name:HODGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1952 WILSON RDG
Mailing Address - Street 2:
Mailing Address - City:MAIDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28650-9345
Mailing Address - Country:US
Mailing Address - Phone:828-428-3624
Mailing Address - Fax:
Practice Address - Street 1:1966 MORGANTON BLVD SW STE B
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-5311
Practice Address - Country:US
Practice Address - Phone:828-426-8477
Practice Address - Fax:828-426-8450
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC096341163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300175KMedicaid
NC096341OtherNC RN LICENSE NUMBER