MEDICARE: DONNA ROSE HODNICKI PHD, FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	73787	NC

General Provider Information

NPI Number	:	1750711123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA ROSE HODNICKI PHD, FNP-BC

Provider Business Mailing Address
First Line	:	149 OCEANGREENS LN
Second Line	:
City	:	OAK ISLAND
State	:	NC
Zip	:	28465-8457
Country	:	US
Telephone Number	:	910-933-4369
Fax Number	:

Provider Business Practice Location Address
First Line	:	1132 EAST CUTLER CROSSING
Second Line	:
City	:	LELAND
State	:	NC
Zip	:	28451
Country	:	US
Telephone Number	:	910-371-1464
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2013
Last Update Date	:	11/20/2013

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