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General NPI Number Information
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NPI Number | 1215016209
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Entity Type | Individual
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Provider Name | REVA HODGE EDD
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Gender | Female
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 12650 W. COUNTY ROAD 1100 N.
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City | GASTON
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State | IN
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Zip | 47342
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Country | US
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Telephone | 765-358-4649
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Fax | 765-358-4650
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Provider Business Mailing Address
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Address Line | 12650 W. COUNTY ROAD
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City | GASTON
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State | IN
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Zip | 47342
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Country | US
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Telephone | 765-358-4649
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Fax | 765-358-4650
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | NONE
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License Number State |
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