Healthcare Provider Details

I. General information

NPI: 1780792473
Provider Name (Legal Business Name): CAROL HODGSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 06/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11820 BERLIN TPKE
LOVETTSVILLE VA
20180-1830
US

IV. Provider business mailing address

11820 BERLIN TPKE
LOVETTSVILLE VA
20180-1830
US

V. Phone/Fax

Practice location:
  • Phone: 703-431-1678
  • Fax: 540-822-5030
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0024165054
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: