Healthcare Provider Details

I. General information

NPI: 1548177819
Provider Name (Legal Business Name): HEATHER HODDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 WELLS RD
LINCOLN MA
01773-3703
US

IV. Provider business mailing address

71 WELLS RD
LINCOLN MA
01773-3703
US

V. Phone/Fax

Practice location:
  • Phone: 508-596-8935
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLN63114
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: