Provider Demographics
NPI:1316606601
Name:HODGINS, DAVID JAY (RN)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:JAY
Last Name:HODGINS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 SHADY LN
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-5456
Mailing Address - Country:US
Mailing Address - Phone:505-326-1972
Mailing Address - Fax:
Practice Address - Street 1:1091 W MURRAY DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-3887
Practice Address - Country:US
Practice Address - Phone:505-324-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR54298163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology