Healthcare Provider Details

I. General information

NPI: 1407939796
Provider Name (Legal Business Name): RONALD KYLE HODGEN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 08/30/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 GATEWAY STE 100B
MASON OH
45040-1890
US

IV. Provider business mailing address

5700 GATEWAY STE 100B
MASON OH
45040-1890
US

V. Phone/Fax

Practice location:
  • Phone: 513-404-4529
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number9281942
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN.CRNA.019367
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: