MEDICARE: ELLEN HODGES CFNP

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	363LF0000X	Family Nurse Practitioner	0024088427	VA

General Provider Information

NPI Number	:	1376546689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLEN HODGES CFNP

Provider Business Mailing Address
First Line	:	8101 HINSON FARM RD
Second Line	:	STE 417
City	:	ALEXANDRIA
State	:	VA
Zip	:	22306-3410
Country	:	US
Telephone Number	:	703-799-4044
Fax Number	:	703-799-4569

Provider Business Practice Location Address
First Line	:	8101 HINSON FARM RD
Second Line	:	STE 417
City	:	ALEXANDRIA
State	:	VA
Zip	:	22306-3410
Country	:	US
Telephone Number	:	703-799-4044
Fax Number	:	703-799-4569

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	07/14/2014

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