Basic Information
| Provider Information | |||||||||
| NPI: | 1841558665 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HODGSON | ||||||||
| FirstName: | CASSANDRA | ||||||||
| MiddleName: | LEIGH | ||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 431 BOXWOOD DR | ||||||||
| Address2: | |||||||||
| City: | SHIRLEY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 119671303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6317724435 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 606 MONTAUK HWY UNIT B | ||||||||
| Address2: | |||||||||
| City: | BAYPORT | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117051632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314196737 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2012 | ||||||||
| LastUpdateDate: | 04/30/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 306104-1 | NY | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.