Healthcare Provider Details

I. General information

NPI: 1548987365
Provider Name (Legal Business Name): GISELLE MONIQUE BODDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2022
Last Update Date: 10/24/2022
Certification Date: 10/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3892 WENDY ANNE CIR
WEST PALM BEACH FL
33417-1057
US

IV. Provider business mailing address

3892 WENDY ANNE CIR
WEST PALM BEACH FL
33417-1057
US

V. Phone/Fax

Practice location:
  • Phone: 561-232-8227
  • Fax:
Mailing address:
  • Phone: 561-232-8227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: