Provider Demographics
NPI:1518373398
Name:BODEUR, CYNTHIA (APRN)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:BODEUR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 HAZARD AVE
Mailing Address - Street 2:SUITE 14
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-4580
Mailing Address - Country:US
Mailing Address - Phone:860-749-3169
Mailing Address - Fax:
Practice Address - Street 1:155 HAZARD AVE
Practice Address - Street 2:SUITE 14
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-4580
Practice Address - Country:US
Practice Address - Phone:860-749-3169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-01
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5828363LP0200X
CT119579163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics