Provider Demographics
NPI:1295372258
Name:HODGE, GILLIANNE PATRICE
Entity Type:Individual
Prefix:
First Name:GILLIANNE
Middle Name:PATRICE
Last Name:HODGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3515 DELMAR DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-9557
Mailing Address - Country:US
Mailing Address - Phone:919-282-2786
Mailing Address - Fax:
Practice Address - Street 1:3400 ORANGE GROVE RD
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278-7639
Practice Address - Country:US
Practice Address - Phone:919-644-1957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider