Provider Demographics
NPI:1063299154
Name:HODOR, MARY KATE
Entity type:Individual
Prefix:
First Name:MARY KATE
Middle Name:
Last Name:HODOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 ADAIR CT
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30157-3826
Mailing Address - Country:US
Mailing Address - Phone:518-649-3742
Mailing Address - Fax:
Practice Address - Street 1:152 ADAIR CT
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30157-3826
Practice Address - Country:US
Practice Address - Phone:518-649-3742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN278905163WN0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care