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NPI Code Detail

MEDICARE: MS. DANIELLE BODDIE RN

MEDICARE: MS. DANIELLE BODDIE RN
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
1163W00000XRegistered Nurse28243685AIN

General Provider Information

NPI Number : 1760080790
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. DANIELLE BODDIE RN
Provider Business Mailing Address
First Line : 5534 SAINT JOE RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46835-3328
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5534 SAINT JOE RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46835-3328
Country : US
Telephone Number : 317-978-1641
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2020
Last Update Date : 10/12/2020

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