Provider Demographics
NPI:1861473183
Name:HODGES, CECIL A (FNP)
Entity Type:Individual
Prefix:MS
First Name:CECIL
Middle Name:A
Last Name:HODGES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-1795
Mailing Address - Country:US
Mailing Address - Phone:781-878-5200
Mailing Address - Fax:781-878-3989
Practice Address - Street 1:75 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1795
Practice Address - Country:US
Practice Address - Phone:781-878-5200
Practice Address - Fax:781-878-3989
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAP46623363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA042297845OtherDOC FIRST
MA53147OtherFALLON
MA0374661Medicaid
042297845OtherPRIVATE HEALTHCARE SYSTEM
NP3627OtherBCBS
042297845OtherGREAT WEST HEALTH CARE
MA042297845OtherTRICARE
MAHONP3627Medicare ID - Type Unspecified
NP3627OtherBCBS