Provider Demographics
NPI:1104079367
Name:BODELL, ASHLEIGH E (PA-C)
Entity type:Individual
Prefix:MS
First Name:ASHLEIGH
Middle Name:E
Last Name:BODELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1702 PALERMO DR
Mailing Address - Street 2:
Mailing Address - City:HUGHSON
Mailing Address - State:CA
Mailing Address - Zip Code:95326-8905
Mailing Address - Country:US
Mailing Address - Phone:909-450-7058
Mailing Address - Fax:
Practice Address - Street 1:1340 MITCHELL RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95351-4920
Practice Address - Country:US
Practice Address - Phone:209-517-9711
Practice Address - Fax:209-581-9703
Is Sole Proprietor?:No
Enumeration Date:2008-10-30
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20015363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant