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General NPI Number Information
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NPI Number | 1073472379
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Entity Type | Organization
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Legal Business Name | THE BODHI CLINIC
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Dates
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Enumeration Date | 01/21/2026
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Last Update Date | 01/21/2026
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Provider Practice Location Address
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Address Line | 3250 W 66TH ST APT 347
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City | EDINA
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State | MN
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Zip | 55435-5512
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Country | US
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Telephone | 218-409-9100
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Fax |
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Provider Business Mailing Address
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Address Line | 3250 W 66TH ST APT 347
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City | EDINA
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State | MN
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Zip | 55435-5512
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Country | US
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Telephone | 218-409-9100
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SAMANTHA CARRY
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Credential | APRN, FNP-C
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Telephone | 612-208-2616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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