Provider Demographics
NPI:1083227797
Name:BEVERLY M HODGES ADVANCED PRACTICE REGISTERED NURSING INC
Entity Type:Organization
Organization Name:BEVERLY M HODGES ADVANCED PRACTICE REGISTERED NURSING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:209-800-4000
Mailing Address - Street 1:814 14TH ST STE E
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-1028
Mailing Address - Country:US
Mailing Address - Phone:209-800-4000
Mailing Address - Fax:
Practice Address - Street 1:814 14TH ST STE E
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-1028
Practice Address - Country:US
Practice Address - Phone:209-800-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1568995546OtherNPI