Provider Demographics
NPI:1982010625
Name:HODGE-HILL, SHANETRA (CRNA)
Entity Type:Individual
Prefix:
First Name:SHANETRA
Middle Name:
Last Name:HODGE-HILL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:SHANETRA
Other - Middle Name:
Other - Last Name:HODGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3026 TEXAS TRAIL LN
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-3262
Mailing Address - Country:US
Mailing Address - Phone:832-515-5757
Mailing Address - Fax:
Practice Address - Street 1:3026 TEXAS TRAIL LN
Practice Address - Street 2:
Practice Address - City:MANVEL
Practice Address - State:TX
Practice Address - Zip Code:77578-3262
Practice Address - Country:US
Practice Address - Phone:832-515-5757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-02
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP125800367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered