Provider Demographics
NPI:1366633497
Name:HODNIK, SHELLEY ANN (RN)
Entity Type:Individual
Prefix:MS
First Name:SHELLEY
Middle Name:ANN
Last Name:HODNIK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 92
Mailing Address - Street 2:
Mailing Address - City:HAINES
Mailing Address - State:AK
Mailing Address - Zip Code:99827-0092
Mailing Address - Country:US
Mailing Address - Phone:907-766-6300
Mailing Address - Fax:907-766-3643
Practice Address - Street 1:131 1ST AVENUE SOUTH
Practice Address - Street 2:SEARHC HAINES HEALTH CENTER
Practice Address - City:HAINES
Practice Address - State:AK
Practice Address - Zip Code:99827
Practice Address - Country:US
Practice Address - Phone:907-766-6300
Practice Address - Fax:907-766-3643
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK22192163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse