MEDICARE: AMANDA RAMOS HODGE MSN, APN, CPNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	563998	TX

General Provider Information

NPI Number	:	1225030489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA RAMOS HODGE MSN, APN, CPNP

Provider Business Mailing Address
First Line	:	1301 BARBARA JORDAN BLVD
Second Line	:	#302
City	:	AUSTIN
State	:	TX
Zip	:	78723-3077
Country	:	US
Telephone Number	:	512-472-6134
Fax Number	:	512-472-2928

Provider Business Practice Location Address
First Line	:	1301 BARBARA JORDAN BLVD
Second Line	:	#302
City	:	AUSTIN
State	:	TX
Zip	:	78723-3077
Country	:	US
Telephone Number	:	512-472-6134
Fax Number	:	512-472-2928

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	07/16/2007

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