Provider Demographics
NPI:1326479411
Name:BODLEY, JACQUELYNE
Entity Type:Individual
Prefix:
First Name:JACQUELYNE
Middle Name:
Last Name:BODLEY
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 1:625 N EUCLID AVE STE 551B
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-1690
Mailing Address - Country:US
Mailing Address - Phone:314-802-8080
Mailing Address - Fax:314-802-8082
Practice Address - Street 1:625 N EUCLID AVE STE 551B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-1690
Practice Address - Country:US
Practice Address - Phone:314-802-8080
Practice Address - Fax:314-802-8082
Is Sole Proprietor?:No
Enumeration Date:2013-11-27
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider