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General NPI Number Information
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NPI Number | 1366051005
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Entity Type | Individual
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Provider Name | STEPHAN JOHN BODNAR
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Gender | Male
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Dates
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Enumeration Date | 07/29/2020
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Last Update Date | 01/02/2026
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Provider Practice Location Address
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Address Line | 7101 JAHNKE RD
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City | RICHMOND
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State | VA
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Zip | 23225-4017
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Country | US
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Telephone | 804-483-0000
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Fax |
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Provider Business Mailing Address
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Address Line | 2114 WINNWOOD RD
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City | HENRICO
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State | VA
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Zip | 23228-6046
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Country | US
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Telephone | 313-580-1040
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Fax |
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 0024180046
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 296000
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License Number State | NC
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