Provider Demographics
NPI:1114238417
Name:BODENDOERFER, RHONDA L (RN)
Entity Type:Individual
Prefix:MS
First Name:RHONDA
Middle Name:L
Last Name:BODENDOERFER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 BELOIT ST
Mailing Address - Street 2:
Mailing Address - City:DELAVAN
Mailing Address - State:WI
Mailing Address - Zip Code:53115-1602
Mailing Address - Country:US
Mailing Address - Phone:262-728-8886
Mailing Address - Fax:
Practice Address - Street 1:116 BELOIT ST
Practice Address - Street 2:
Practice Address - City:DELAVAN
Practice Address - State:WI
Practice Address - Zip Code:53115-1602
Practice Address - Country:US
Practice Address - Phone:262-728-8886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-01
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI122190-30163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health