Healthcare Provider Details

I. General information

NPI: 1083227797
Provider Name (Legal Business Name): BEVERLY M HODGES ADVANCED PRACTICE REGISTERED NURSING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

814 14TH ST STE E
MODESTO CA
95354-1028
US

IV. Provider business mailing address

814 14TH ST STE E
MODESTO CA
95354-1028
US

V. Phone/Fax

Practice location:
  • Phone: 209-800-4000
  • Fax:
Mailing address:
  • Phone: 209-800-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BEVERLY HODGES
Title or Position: PROVIDER
Credential: NP
Phone: 209-800-4000