Provider Demographics
NPI:1841558665
Name:HODGSON, CASSANDRA LEIGH (LPN)
Entity Type:Individual
Prefix:MISS
First Name:CASSANDRA
Middle Name:LEIGH
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 1:431 BOXWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SHIRLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11967-1303
Mailing Address - Country:US
Mailing Address - Phone:631-772-4435
Mailing Address - Fax:
Practice Address - Street 1:606 MONTAUK HWY UNIT B
Practice Address - Street 2:
Practice Address - City:BAYPORT
Practice Address - State:NY
Practice Address - Zip Code:11705-1632
Practice Address - Country:US
Practice Address - Phone:631-419-6737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY306104-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse