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NPI Code Detail

MEDICARE: MRS. TANYA LANE BODO

MEDICARE: MRS. TANYA LANE BODO
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
1367A00000XAdvanced Practice Midwife727251TX

General Provider Information

NPI Number : 1740472455
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. TANYA LANE BODO
Provider Business Mailing Address
First Line : 117 S WILLIAM BARNETT AVE
Second Line : SUITE A
City : CLEVELAND
State : TX
Zip : 77327-4541
Country : US
Telephone Number : 281-593-1660
Fax Number :
Provider Business Practice Location Address
First Line : 117 S WILLIAM BARNETT AVE
Second Line : SUITE A
City : CLEVELAND
State : TX
Zip : 77327-4541
Country : US
Telephone Number : 281-593-1660
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2007
Last Update Date : 08/16/2007

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Directions to “ MRS. TANYA LANE BODO ” Practice Location

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