Provider Demographics
NPI:1841442563
Name:HODGE, GEORGENE
Entity type:Individual
Prefix:MS
First Name:GEORGENE
Middle Name:
Last Name:HODGE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:GEORGENE
Other - Middle Name:
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN/ WOUND NURSE
Mailing Address - Street 1:19716 MEADOWLARK LN
Mailing Address - Street 2:1
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-2747
Mailing Address - Country:US
Mailing Address - Phone:216-357-8758
Mailing Address - Fax:
Practice Address - Street 1:19716 MEADOWLARK LN
Practice Address - Street 2:1
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-2747
Practice Address - Country:US
Practice Address - Phone:216-357-8758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-13
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.091383164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse