Provider Demographics
NPI:1215599444
Name:BODEMER, RACHEL LYNN (NP)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:LYNN
Last Name:BODEMER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 WASHINGTON ST STE 220
Mailing Address - Street 2:
Mailing Address - City:NORTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02356-1034
Mailing Address - Country:US
Mailing Address - Phone:508-230-0155
Mailing Address - Fax:508-230-0145
Practice Address - Street 1:3 WASHINGTON ST STE 220
Practice Address - Street 2:
Practice Address - City:NORTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02356-1034
Practice Address - Country:US
Practice Address - Phone:508-230-0155
Practice Address - Fax:508-230-0145
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAF06192822207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine