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NPI Code Detail

MEDICARE: CRYSTAL M. HODGE

MEDICARE: CRYSTAL M. HODGE
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
1363LA2200XAdult Health Nurse PractitionerAPRN.CNP.0030756OH

General Provider Information

NPI Number : 1508511692
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRYSTAL M. HODGE
Provider Business Mailing Address
First Line : 6094 DAWSON DR
Second Line :
City : LIBERTY TWP
State : OH
Zip : 45044-1254
Country : US
Telephone Number : 513-869-9322
Fax Number :
Provider Business Practice Location Address
First Line : 4850 SMITH RD STE 250
Second Line :
City : CINCINNATI
State : OH
Zip : 45212-2733
Country : US
Telephone Number : 513-699-9090
Fax Number : 513-258-2053
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/16/2022
Last Update Date : 06/25/2024

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