Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | RO87926 | MD |
NPI | 1003803446 |
---|---|
Provider Name | Janice Elaine Hodge |
First Address | Montgomry Village, MD 20886-3109 |
Second Address | Rockville, MD 20850-4008 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2005 |
Last Update Date | 18/03/2009 |