Provider Demographics
NPI:1619228392
Name:HODGSON, MEREDITH LEE (ARNP)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:LEE
Last Name:HODGSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:LEE
Other - Last Name:BURRILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1236 E RUSHOLME ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-2434
Mailing Address - Country:US
Mailing Address - Phone:563-324-2992
Mailing Address - Fax:563-324-8562
Practice Address - Street 1:1236 E RUSHOLME ST
Practice Address - Street 2:SUITE 300
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-2434
Practice Address - Country:US
Practice Address - Phone:563-324-2992
Practice Address - Fax:563-324-8562
Is Sole Proprietor?:No
Enumeration Date:2012-09-21
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAL109406363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care