Provider Demographics
NPI:1821682022
Name:HODGES, MADELINE MICHELLE (CBS)
Entity Type:Individual
Prefix:
First Name:MADELINE
Middle Name:MICHELLE
Last Name:HODGES
Suffix:
Gender:F
Credentials:CBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5696 ROSE TIARA DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-6960
Mailing Address - Country:US
Mailing Address - Phone:702-785-1614
Mailing Address - Fax:
Practice Address - Street 1:5696 ROSE TIARA DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89139-6960
Practice Address - Country:US
Practice Address - Phone:702-785-1614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-27
Last Update Date:2021-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Single Specialty