Provider Demographics
NPI:1376514844
Name:BODKHE, ANN W (MSN, ANP-BC)
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:W
Last Name:BODKHE
Suffix:
Gender:F
Credentials:MSN, ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 SHEPHARD RD
Mailing Address - Street 2:
Mailing Address - City:CHARLEMONT
Mailing Address - State:MA
Mailing Address - Zip Code:01339-9720
Mailing Address - Country:US
Mailing Address - Phone:413-625-9455
Mailing Address - Fax:
Practice Address - Street 1:51 SANDERSON ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-2711
Practice Address - Country:US
Practice Address - Phone:413-772-6040
Practice Address - Fax:413-772-6045
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA178403363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0320978Medicaid
MAS77098Medicare UPIN
MA0320978Medicaid