Provider Demographics
NPI:1053641522
Name:BODINE, ELAINE ELIZABETH (LNP)
Entity Type:Individual
Prefix:MISS
First Name:ELAINE
Middle Name:ELIZABETH
Last Name:BODINE
Suffix:
Gender:F
Credentials:LNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4828 ARNOLD RD
Mailing Address - Street 2:
Mailing Address - City:RUSHVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14544-9715
Mailing Address - Country:US
Mailing Address - Phone:731-363-4872
Mailing Address - Fax:
Practice Address - Street 1:4828 ARNOLD RD
Practice Address - Street 2:
Practice Address - City:RUSHVILLE
Practice Address - State:NY
Practice Address - Zip Code:14544-9715
Practice Address - Country:US
Practice Address - Phone:731-363-4872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2431531164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse