Provider Demographics
NPI:1003803446
Name:HODGE, JANICE ELAINE (CRNP)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:ELAINE
Last Name:HODGE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9509 WHETSTONE DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMRY VILLAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20886-3109
Mailing Address - Country:US
Mailing Address - Phone:301-926-4627
Mailing Address - Fax:
Practice Address - Street 1:15825 SHADY GROVE RD
Practice Address - Street 2:STE 140
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-4008
Practice Address - Country:US
Practice Address - Phone:301-869-9776
Practice Address - Fax:301-216-2592
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRO87926363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner