Provider Demographics
NPI:1831740943
Name:HODGE, WENDY
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:HODGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3152 OAK DR SW
Mailing Address - Street 2:
Mailing Address - City:SHALLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28470-5959
Mailing Address - Country:US
Mailing Address - Phone:910-618-8775
Mailing Address - Fax:910-754-2208
Practice Address - Street 1:3152 OAK DR SW
Practice Address - Street 2:
Practice Address - City:SHALLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28470-5959
Practice Address - Country:US
Practice Address - Phone:910-618-8775
Practice Address - Fax:910-754-2208
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider