Provider Demographics
NPI:1699178319
Name:BODNER, ELIZABETH KATHARINE (ARNP, CNM)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:KATHARINE
Last Name:BODNER
Suffix:
Gender:F
Credentials:ARNP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 ELLIS ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4905
Mailing Address - Country:US
Mailing Address - Phone:360-734-9095
Mailing Address - Fax:360-715-8416
Practice Address - Street 1:1530 ELLIS ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4905
Practice Address - Country:US
Practice Address - Phone:360-734-9095
Practice Address - Fax:360-715-8416
Is Sole Proprietor?:No
Enumeration Date:2014-10-08
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60510330363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner