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General NPI Number Information
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NPI Number | 1356211957
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Entity Type | Individual
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Provider Name | SHANIEKA NASHAE HODGE
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Gender | Female
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Dates
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Enumeration Date | 11/08/2025
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Last Update Date | 11/08/2025
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Provider Practice Location Address
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Address Line | 839 S 165TH DR
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City | GOODYEAR
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State | AZ
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Zip | 85338-4590
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Country | US
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Telephone | 623-326-7607
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Fax |
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Provider Business Mailing Address
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Address Line | 839 S 165TH DR
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City | GOODYEAR
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State | AZ
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Zip | 85338-4590
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Country | US
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Telephone | 623-326-7607
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Fax |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 268652
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License Number State | AZ
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