Provider Demographics
NPI:1013127042
Name:BODO, TERA LYNN (RN)
Entity Type:Individual
Prefix:MRS
First Name:TERA
Middle Name:LYNN
Last Name:BODO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 VIA SONRISA
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-5669
Mailing Address - Country:US
Mailing Address - Phone:949-366-0753
Mailing Address - Fax:949-366-0753
Practice Address - Street 1:50 VIA SONRISA
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-5669
Practice Address - Country:US
Practice Address - Phone:949-366-0753
Practice Address - Fax:949-366-0753
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA538369163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse