Provider Demographics
NPI:1417429739
Name:HODOWANIC, MORGAN BRITTNEY
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:BRITTNEY
Last Name:HODOWANIC
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 1:2045 WILDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-6582
Mailing Address - Country:US
Mailing Address - Phone:815-319-5834
Mailing Address - Fax:
Practice Address - Street 1:2045 WILDWOOD DR
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-6582
Practice Address - Country:US
Practice Address - Phone:815-319-5834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-27
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX339283164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse