Provider Demographics
NPI:1497311906
Name:BODE, COURTNEY DAWN (CNP)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:DAWN
Last Name:BODE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12320 BEECHTREE CT N
Mailing Address - Street 2:
Mailing Address - City:THORNVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43076-8034
Mailing Address - Country:US
Mailing Address - Phone:740-403-8441
Mailing Address - Fax:
Practice Address - Street 1:6001 E BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-1502
Practice Address - Country:US
Practice Address - Phone:614-234-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-10
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.024637363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily