Healthcare Provider Details

I. General information

NPI: 1083929962
Provider Name (Legal Business Name): DIANA C. HODLOFSKI N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2010
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 ATLANTIC PL STE 100
S PORTLAND ME
04106-2316
US

IV. Provider business mailing address

1217 E 10TH AVE
ANCHORAGE AK
99501-4003
US

V. Phone/Fax

Practice location:
  • Phone: 225-407-9143
  • Fax:
Mailing address:
  • Phone: 603-717-2699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberCNP241150
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: