Provider Demographics
NPI:1104680404
Name:HODGE, PAULA JEAN (LPN)
Entity type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:JEAN
Last Name:HODGE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:PAULA
Other - Middle Name:JEAN
Other - Last Name:COUSINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:14930 LAPLAISANCE RD STE 127
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-3878
Mailing Address - Country:US
Mailing Address - Phone:734-344-5269
Mailing Address - Fax:
Practice Address - Street 1:5556 CENTRAL DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-3678
Practice Address - Country:US
Practice Address - Phone:734-790-5394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703092744164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse