Healthcare Provider Details

I. General information

NPI: 1609825918
Provider Name (Legal Business Name): LISA BODNAR ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6282 LINTON BLVD
DELRAY BEACH FL
33484-6416
US

IV. Provider business mailing address

6282 LINTON BLVD
DELRAY BEACH FL
33484-6416
US

V. Phone/Fax

Practice location:
  • Phone: 561-495-8307
  • Fax: 561-495-6422
Mailing address:
  • Phone: 561-495-8307
  • Fax: 561-495-6422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9189715
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: