Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 4704244194 | MI |
NPI | 1023484235 |
---|---|
Provider Name | Daniel Hodge |
First Address | Kalamazoo, MI 49007-2557 |
Second Address | Kalamazoo, MI 49007-2557 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2015 |
Last Update Date | 15/09/2015 |