Provider Demographics
NPI:1215071253
Name:HODGES, NANCY DAVIS (MS, RN, CS)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:DAVIS
Last Name:HODGES
Suffix:
Gender:F
Credentials:MS, RN, CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26085 NW DIXIE MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:SCAPPOOSE
Mailing Address - State:OR
Mailing Address - Zip Code:97056-9503
Mailing Address - Country:US
Mailing Address - Phone:503-621-3955
Mailing Address - Fax:
Practice Address - Street 1:1130 SW MORRISON ST
Practice Address - Street 2:SUITE 619
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2234
Practice Address - Country:US
Practice Address - Phone:503-260-0802
Practice Address - Fax:503-248-0975
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR000023665RN364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR108985Medicare ID - Type Unspecified