Provider Demographics
NPI:1104113844
Name:HODGE, BERNICE MATEE (LPN)
Entity type:Individual
Prefix:
First Name:BERNICE
Middle Name:MATEE
Last Name:HODGE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 S GREEN RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-2320
Mailing Address - Country:US
Mailing Address - Phone:216-481-1804
Mailing Address - Fax:
Practice Address - Street 1:285 S GREEN RD
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-2320
Practice Address - Country:US
Practice Address - Phone:216-481-1804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-01
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH081877164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse