Healthcare Provider Details

I. General information

NPI: 1932723897
Provider Name (Legal Business Name): KATHRYN L BODE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2020
Last Update Date: 06/05/2020
Certification Date: 06/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8501 RANCHO DEL CERRO DR NE
ALBUQUERQUE NM
87113-2076
US

IV. Provider business mailing address

8501 RANCHO DEL CERRO DR NE
ALBUQUERQUE NM
87113-2076
US

V. Phone/Fax

Practice location:
  • Phone: 505-480-3290
  • Fax:
Mailing address:
  • Phone: 505-480-3290
  • Fax: 505-207-1372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: