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General NPI Number Information
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NPI Number | 1760341903
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Entity Type | Individual
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Provider Name | MICHAL BODLAK
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Gender | Male
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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 | 14821 HANOVER ST
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City | BENNINGTON
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State | NE
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Zip | 68007-1523
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Country | US
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Telephone | 531-205-8920
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Fax |
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Provider Business Mailing Address
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Address Line | 14821 HANOVER ST
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City | BENNINGTON
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State | NE
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Zip | 68007-1523
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Country | US
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Telephone |
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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 | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number | 79942
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License Number State | NE
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