Provider Demographics
NPI:1235797622
Name:HODGES, CHRISTINA (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:HODGES
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 W LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:MO
Mailing Address - Zip Code:65084-1346
Mailing Address - Country:US
Mailing Address - Phone:573-378-5438
Mailing Address - Fax:573-378-7375
Practice Address - Street 1:104 W LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:MO
Practice Address - Zip Code:65084-1346
Practice Address - Country:US
Practice Address - Phone:573-378-5438
Practice Address - Fax:573-378-7375
Is Sole Proprietor?:No
Enumeration Date:2019-05-31
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010021891163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant