Provider Demographics
NPI:1083926521
Name:SPARROW-BODENMILLER, JANE LESLEY (RN CDE)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:LESLEY
Last Name:SPARROW-BODENMILLER
Suffix:
Gender:F
Credentials:RN CDE
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1500 NW 12TH AVE, E-1007
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1005
Mailing Address - Country:US
Mailing Address - Phone:305-243-4664
Mailing Address - Fax:305-243-9927
Practice Address - Street 1:1500 NW 12TH AVE STE 1007
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1046
Practice Address - Country:US
Practice Address - Phone:305-243-4664
Practice Address - Fax:305-243-9927
Is Sole Proprietor?:No
Enumeration Date:2010-07-13
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLRN 1061832163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator