Provider Demographics
NPI:1770831356
Name:HODGE, NATASHA NICOLE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:NATASHA
Middle Name:NICOLE
Last Name:HODGE
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 1:196 BALSAM CT
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:OH
Mailing Address - Zip Code:45246-2402
Mailing Address - Country:US
Mailing Address - Phone:513-387-9949
Mailing Address - Fax:
Practice Address - Street 1:196 BALSAM CT
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:OH
Practice Address - Zip Code:45246-2402
Practice Address - Country:US
Practice Address - Phone:513-387-9949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.129925.MEDS-IV164W00000X
KY2047179164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1730894668OtherNPPES