Healthcare Provider Details

I. General information

NPI: 1275678138
Provider Name (Legal Business Name): JANE ELIZABETH BODDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANE BODDEN NP

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E BOULDER ST
COLORADO SPRINGS CO
80909-5533
US

IV. Provider business mailing address

P.O. BOX 173891
DENVER CO
80217-9294
US

V. Phone/Fax

Practice location:
  • Phone: 719-365-6820
  • Fax: 303-306-7753
Mailing address:
  • Phone: 303-306-7783
  • Fax: 303-306-7753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number96228
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: