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General NPI Number Information
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NPI Number | 1245375625
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Entity Type | Individual
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Provider Name | TERESA A HODGSON PAC
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Gender | Female
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 406 E 1ST ST
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City | TRENTON
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State | NE
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Zip | 69044-1715
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Country | US
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Telephone | 308-334-5155
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Fax | 308-334-5144
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Provider Business Mailing Address
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Address Line | 307 ELIZABETH LN
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City | MCCOOK
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State | NE
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Zip | 69001-2228
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Country | US
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Telephone | 308-345-5696
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Fax | 308-334-5144
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 720
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License Number State | NE
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