Provider Demographics
NPI:1740801364
Name:HODGSON, XOCHITL (LPN)
Entity Type:Individual
Prefix:
First Name:XOCHITL
Middle Name:
Last Name:HODGSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 CREEKSIDE LN
Mailing Address - Street 2:
Mailing Address - City:HOPE
Mailing Address - State:ID
Mailing Address - Zip Code:83836-9641
Mailing Address - Country:US
Mailing Address - Phone:208-264-8555
Mailing Address - Fax:
Practice Address - Street 1:28 CREEKSIDE LN
Practice Address - Street 2:
Practice Address - City:HOPE
Practice Address - State:ID
Practice Address - Zip Code:83836-9641
Practice Address - Country:US
Practice Address - Phone:760-644-9373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-05
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPN50215164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse