Provider Demographics
NPI:1275263642
Name:HODGE, BETH CATHRYN (LPN)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:CATHRYN
Last Name:HODGE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:CATHRYN
Other - Last Name:MYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:8 KING FISHER LN
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-4656
Mailing Address - Country:US
Mailing Address - Phone:863-899-2403
Mailing Address - Fax:
Practice Address - Street 1:87 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:RENSSELAER
Practice Address - State:NY
Practice Address - Zip Code:12144-2613
Practice Address - Country:US
Practice Address - Phone:518-449-1142
Practice Address - Fax:518-449-1320
Is Sole Proprietor?:No
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234437164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse