Provider Demographics
NPI:1205108255
Name:HODGE, JENNIFER L (LPN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:HODGE
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 1:725 MAPLE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-1408
Mailing Address - Country:US
Mailing Address - Phone:513-301-5403
Mailing Address - Fax:
Practice Address - Street 1:725 MAPLE RIDGE RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-1408
Practice Address - Country:US
Practice Address - Phone:513-301-5403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-07
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN. 144684-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse