Healthcare Provider Details

I. General information

NPI: 1841299948
Provider Name (Legal Business Name): JACQUELYNE ANNE BODDEN MSN RN-C WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 CADILLAC DR
PLATTEVILLE WI
53818-3918
US

IV. Provider business mailing address

1010 CADILLAC DR
PLATTEVILLE WI
53818-3918
US

V. Phone/Fax

Practice location:
  • Phone: 608-348-7275
  • Fax:
Mailing address:
  • Phone: 608-348-7275
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number1476
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number1476-033
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: