Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 4704330179 | MI |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 4704330179 | MI |
NPI | 1265077408 |
---|---|
Provider Name | Mrs. Megan Nicole Hodson |
First Address | Harper Woods, MI 48225-1744 |
Second Address | Detroit, MI 48202-2689 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/11/2019 |
Last Update Date | 14/11/2019 |