MEDICARE: J'ANGELIQUE BODDIE

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	164W00000X	Licensed Practical Nurse	145329	OH

General Provider Information

NPI Number	:	1326864836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	J'ANGELIQUE BODDIE

Provider Business Mailing Address
First Line	:	2046 HAVENSWOOD PL
Second Line	:
City	:	BLACKLICK
State	:	OH
Zip	:	43004-8513
Country	:	US
Telephone Number	:	614-483-9192
Fax Number	:	614-861-4601

Provider Business Practice Location Address
First Line	:	6116 MCNAUGHTEN CTR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43232-1641
Country	:	US
Telephone Number	:	614-483-9192
Fax Number	:	614-861-4601

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2024
Last Update Date	:	11/29/2024

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Directions to “ J'ANGELIQUE BODDIE ” Practice Location

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