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General NPI Number Information
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NPI Number | 1487041539
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Entity Type | Individual
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Provider Name | JEANNE BODNER NP
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Gender | Female
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Dates
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Enumeration Date | 04/15/2015
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Last Update Date | 09/07/2021
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Provider Practice Location Address
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Address Line | 101 ELM AVE SE
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City | ROANOKE
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State | VA
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Zip | 24013-2222
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Country | US
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Telephone | 540-981-7001
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Fax |
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Provider Business Mailing Address
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Address Line | 210 DRAKE LNDG
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City | NEW BERN
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State | NC
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Zip | 28560-8416
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Country | US
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Telephone | 484-319-2515
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | NPAG0115122
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License Number State | NC
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