Healthcare Provider Details

I. General information

NPI: 1295171460
Provider Name (Legal Business Name): EMILY J HODGES CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2013
Last Update Date: 01/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 OLD DOCK TRL
CARY NC
27519-6900
US

IV. Provider business mailing address

3100 SPRING FOREST RD SUITE 130
RALEIGH NC
27616-2880
US

V. Phone/Fax

Practice location:
  • Phone: 919-656-4634
  • Fax:
Mailing address:
  • Phone: 919-873-9533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number100956
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number188649
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: