Provider Demographics
NPI:1770156986
Name:HODGES, LABRICIA WILLIAMS (RN BSN)
Entity type:Individual
Prefix:PROF
First Name:LABRICIA
Middle Name:WILLIAMS
Last Name:HODGES
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 RALEIGH ST
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27565-3738
Mailing Address - Country:US
Mailing Address - Phone:919-672-2814
Mailing Address - Fax:
Practice Address - Street 1:614 RALEIGH ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565-3738
Practice Address - Country:US
Practice Address - Phone:919-672-2814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-24
Last Update Date:2021-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC250288163WC0400X, 163WH1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH1000XNursing Service ProvidersRegistered NurseHospice
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
0OtherDISABILITY