Provider Demographics
NPI:1942967252
Name:HODEN, STEPHANIE MAE (FNP-C)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MAE
Last Name:HODEN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 SAYBROOK RD
Mailing Address - Street 2:
Mailing Address - City:SHEFFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16347-2635
Mailing Address - Country:US
Mailing Address - Phone:814-779-1885
Mailing Address - Fax:
Practice Address - Street 1:2 W CRESCENT PARK
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-2199
Practice Address - Country:US
Practice Address - Phone:814-723-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-22
Last Update Date:2021-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP024863363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner