Provider Demographics
NPI:1144806282
Name:BODDIE, JIHAN
Entity Type:Individual
Prefix:
First Name:JIHAN
Middle Name:
Last Name:BODDIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1635 VANCOUVER DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-4751
Mailing Address - Country:US
Mailing Address - Phone:937-540-5000
Mailing Address - Fax:
Practice Address - Street 1:1829 WEAVER ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-4539
Practice Address - Country:US
Practice Address - Phone:937-993-3619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-19
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide