MEDICARE: MIRANDA LEIGH HODGE CNP

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	363LA2100X	Acute Care Nurse Practitioner	4704374825	OH

General Provider Information

NPI Number	:	1578865093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRANDA LEIGH HODGE CNP

Provider Business Mailing Address
First Line	:	840 NW WASHINGTON BLVD STE C
Second Line	:
City	:	HAMILTON
State	:	OH
Zip	:	45013-6381
Country	:	US
Telephone Number	:	513-737-7246
Fax Number	:	513-737-6601

Provider Business Practice Location Address
First Line	:	840 NW WASHINGTON BLVD STE C
Second Line	:
City	:	HAMILTON
State	:	OH
Zip	:	45013-6381
Country	:	US
Telephone Number	:	513-737-7246
Fax Number	:	513-737-6601

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

Provider Enumeration Date	:	12/04/2010
Last Update Date	:	03/23/2026

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