Healthcare Provider Details

I. General information

NPI: 1104236371
Provider Name (Legal Business Name): LAUREN A HODGSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2014
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2925 RYAN DR SE
SALEM OR
97301-9687
US

IV. Provider business mailing address

2925 RYAN DR SE
SALEM OR
97301-9687
US

V. Phone/Fax

Practice location:
  • Phone: 503-399-1262
  • Fax:
Mailing address:
  • Phone: 503-763-7471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA175874
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberPA175874
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: