Provider Demographics
NPI:1780964932
Name:HODGE, MICHAEL ALEXANDER (CNP, PMHNP,MSN)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ALEXANDER
Last Name:HODGE
Suffix:
Gender:M
Credentials:CNP, PMHNP,MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7282 BROOKE BLVD
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-5274
Mailing Address - Country:US
Mailing Address - Phone:347-451-2739
Mailing Address - Fax:
Practice Address - Street 1:7282 BROOKE BLVD
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-5274
Practice Address - Country:US
Practice Address - Phone:347-451-2739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-19
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.362463163W00000X
OH025996363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse