Provider Demographics
NPI:1790436848
Name:BODDEN, TERRIE ALICE (RN, MSN)
Entity Type:Individual
Prefix:
First Name:TERRIE
Middle Name:ALICE
Last Name:BODDEN
Suffix:
Gender:F
Credentials:RN, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2224 LITCHWOOD LN
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-2219
Mailing Address - Country:US
Mailing Address - Phone:504-339-4496
Mailing Address - Fax:
Practice Address - Street 1:111 N CAUSEWAY BLVD
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-5450
Practice Address - Country:US
Practice Address - Phone:504-838-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA152303163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse