Individual
DEANNA HODNICKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
112 HILL POND LN, STATESBORO, GA 30458-0872
(912) 489-3325
(912) 489-7334
Mailing address
112 HILL POND LN, STATESBORO, GA 30458-0872
(912) 489-3325
(912) 489-7334
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
RN104429
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003106473C
—
GA
Enumeration date
02/03/2010
Last updated
11/06/2015
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