Provider Demographics
NPI:1932721545
Name:BODENBENDER, ABBIE VERENE
Entity Type:Individual
Prefix:
First Name:ABBIE
Middle Name:VERENE
Last Name:BODENBENDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15905 WISCONSIN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:BOSCOBEL
Mailing Address - State:WI
Mailing Address - Zip Code:53805-9119
Mailing Address - Country:US
Mailing Address - Phone:608-391-0146
Mailing Address - Fax:
Practice Address - Street 1:1591 PARTRIDGE HILL DR
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:WI
Practice Address - Zip Code:53575-2567
Practice Address - Country:US
Practice Address - Phone:608-485-1726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-18
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI321824164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse