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General NPI Number Information
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NPI Number | 1114525706
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Entity Type | Individual
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Provider Name | JENNIFER BODINE FNP
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Gender | Female
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Dates
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Enumeration Date | 10/15/2020
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Last Update Date | 06/09/2021
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Provider Practice Location Address
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Address Line | 736 BATTLEFIELD BLVD N
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City | CHESAPEAKE
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State | VA
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Zip | 23320-4941
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Country | US
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Telephone | 757-312-8121
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 11314
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City | BELFAST
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State | ME
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Zip | 04915-4004
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Country | US
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Telephone | 757-842-4481
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Fax | 757-312-3135
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024179734
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License Number State | VA
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