MEDICARE: THE BODHI CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1073472379
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE BODHI CLINIC

Provider Business Mailing Address
First Line	:	3250 W 66TH ST APT 347
Second Line	:
City	:	EDINA
State	:	MN
Zip	:	55435-5512
Country	:	US
Telephone Number	:	218-409-9100
Fax Number	:

Provider Business Practice Location Address
First Line	:	3250 W 66TH ST APT 347
Second Line	:
City	:	EDINA
State	:	MN
Zip	:	55435-5512
Country	:	US
Telephone Number	:	218-409-9100
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SAMANTHA CARRY
Credential	:	APRN, FNP-C
Telephone Number	:	612-208-2616

Provider Enumeration Date	:	01/21/2026
Last Update Date	:	02/20/2026

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Directions to “THE BODHI CLINIC ” Practice Location

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