MEDICARE: SARAH ELIZABETH HODGE CRNA

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	367500000X	Certified Registered Nurse Anesthetist	13505	TN
2	367500000X	Certified Registered Nurse Anesthetist	R873099	MS

General Provider Information

NPI Number	:	1285828020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH ELIZABETH HODGE CRNA

Provider Business Mailing Address
First Line	:	10120 GREEN RIVER RD
Second Line	:
City	:	LAKE CORMORANT
State	:	MS
Zip	:	38641-9642
Country	:	US
Telephone Number	:	901-831-0930
Fax Number	:

Provider Business Practice Location Address
First Line	:	1310 WOLF PARK DR
Second Line	:
City	:	GERMANTOWN
State	:	TN
Zip	:	38138
Country	:	US
Telephone Number	:	901-624-5151
Fax Number	:

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

Provider Enumeration Date	:	09/05/2007
Last Update Date	:	08/19/2024

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