Healthcare Provider Details

I. General information

NPI: 1942258421
Provider Name (Legal Business Name): NEAL EDWARD HODGKIN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 10/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15747 W 150TH ST
OLATHE KS
66062-4780
US

IV. Provider business mailing address

15747 W 150TH ST
OLATHE KS
66062-4780
US

V. Phone/Fax

Practice location:
  • Phone: 913-764-5075
  • Fax: 913-764-2979
Mailing address:
  • Phone: 913-764-5075
  • Fax: 913-764-2979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number100447
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: