Provider Demographics
NPI:1043963572
Name:HODGES, JANESSA MERINDA (CNM)
Entity Type:Individual
Prefix:
First Name:JANESSA
Middle Name:MERINDA
Last Name:HODGES
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 S SPRING CANYON WAY
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-5403
Mailing Address - Country:US
Mailing Address - Phone:801-400-8825
Mailing Address - Fax:
Practice Address - Street 1:1248 E 90 N # 300
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2956
Practice Address - Country:US
Practice Address - Phone:801-756-9635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT106522584402367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife