Provider Demographics
NPI:1811957947
Name:WALKER HODGES, WANDA CHARLENE (CRNA)
Entity type:Individual
Prefix:MRS
First Name:WANDA
Middle Name:CHARLENE
Last Name:WALKER HODGES
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 WIGEON CT
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-7083
Mailing Address - Country:US
Mailing Address - Phone:301-218-2195
Mailing Address - Fax:
Practice Address - Street 1:1304 WIGEON CT
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-7083
Practice Address - Country:US
Practice Address - Phone:301-218-2195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC752367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAN0722Medicaid
SCAN0722Medicaid