Provider Demographics
NPI:1083229504
Name:BODAMER, PEGGY MARIA (RN)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:MARIA
Last Name:BODAMER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:PEGGY
Other - Middle Name:MARIA
Other - Last Name:ECHEVERRIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:5475 S 500 E
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405-6905
Mailing Address - Country:US
Mailing Address - Phone:801-479-2560
Mailing Address - Fax:
Practice Address - Street 1:5475 S 500 E
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-6905
Practice Address - Country:US
Practice Address - Phone:801-479-2560
Practice Address - Fax:801-479-2995
Is Sole Proprietor?:No
Enumeration Date:2020-09-11
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT73370543102363LN0000X
UT7337054-3102163WN0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care
No363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal