Provider Demographics
NPI:1528406584
Name:HODGE, LEZLEE
Entity Type:Individual
Prefix:
First Name:LEZLEE
Middle Name:
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 1:5102 E PIEDMONT RD APT 2205
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-8617
Mailing Address - Country:US
Mailing Address - Phone:602-758-5077
Mailing Address - Fax:
Practice Address - Street 1:5102 E PIEDMONT RD APT 2205
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-8617
Practice Address - Country:US
Practice Address - Phone:602-758-5077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies