Provider Demographics
NPI:1639555436
Name:HODGES, STEPHANIE (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:HODGES
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 OAK ST SE
Mailing Address - Street 2:STE 3040
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3906
Mailing Address - Country:US
Mailing Address - Phone:503-472-6161
Mailing Address - Fax:503-434-6290
Practice Address - Street 1:2435 NE CUMULUS AVE STE A
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-8805
Practice Address - Country:US
Practice Address - Phone:503-472-6161
Practice Address - Fax:503-434-6290
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201505345NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500690362Medicaid
ORP01666187OtherRAILROAD MEDICARE
OR1407812365OtherGROUP NPI NORTH BEND MEDICAL CENTER
OR500690362Medicaid
ORR0000WFBTVOtherGROUP MEDICARE NORTH BEND MEDICAL CENTER
OR161133OtherGROUP DMAP NORTH BEND MEDICAL CENTER
ORP01666187OtherRAILROAD MEDICARE