Provider Demographics
NPI:1902204480
Name:BODH-CERES, RAJPATI (NP)
Entity Type:Individual
Prefix:
First Name:RAJPATI
Middle Name:
Last Name:BODH-CERES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:38384-6003
Mailing Address - Country:US
Mailing Address - Phone:731-727-8012
Mailing Address - Fax:
Practice Address - Street 1:209 S HIGH ST
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:TN
Practice Address - Zip Code:38485-2605
Practice Address - Country:US
Practice Address - Phone:228-865-1330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-15
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21248363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY461899OtherRN LICENSE