Provider Demographics
NPI:1043394604
Name:BODOH, JAMES E (CRNA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:BODOH
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W3985 COUNTY ROAD NN
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:WI
Mailing Address - Zip Code:53121-4337
Mailing Address - Country:US
Mailing Address - Phone:262-741-2037
Mailing Address - Fax:
Practice Address - Street 1:W3985 COUNTY ROAD NN
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:WI
Practice Address - Zip Code:53121-4337
Practice Address - Country:US
Practice Address - Phone:262-741-2037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI44932367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43282000Medicaid
MN27G29BOOtherBCBS MN FACILITY
MN843042000Medicaid
MN20-00293OtherMEDICA
MN64Q23BOOtherBCBS MN PRO FEE
MNNA9031006543OtherPREFERRED ONE
MNHP10148OtherHEALTHPARTNERS
MN20-00293OtherMEDICA
WI211700001Medicare ID - Type Unspecified