=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083929962
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DIANA C. HODLOFSKI N.P.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/16/2010
-----------------------------------------------------
Last Update Date | 11/13/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 34 ATLANTIC PL STE 100
-----------------------------------------------------
City | S PORTLAND
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04106-2316
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-407-9143
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1217 E 10TH AVE
-----------------------------------------------------
City | ANCHORAGE
-----------------------------------------------------
State | AK
-----------------------------------------------------
Zip | 99501-4003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-717-2699
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 364SF0001X
-----------------------------------------------------
Taxonomy Name | Family Health Clinical Nurse Specialist
-----------------------------------------------------
License Number | CNP241150
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------