Healthcare Provider Details

I. General information

NPI: 1568839512
Provider Name (Legal Business Name): KAY BODUDE MSN, BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2015
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 W HATCHER RD STE 206
PHOENIX AZ
85021-2493
US

IV. Provider business mailing address

7067 W JACKRABBIT LN
PEORIA AZ
85383-6018
US

V. Phone/Fax

Practice location:
  • Phone: 602-675-1686
  • Fax: 602-675-1703
Mailing address:
  • Phone: 602-675-1686
  • Fax: 602-675-1703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number11-3766310
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: