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Individual
JOHANNA CONGLETON BODINE
Active
Individual
JOHANNA CONGLETON BODINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNM
Taxonomy
Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
Primary
CNM1795
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15228
RX AUTH #
TX
05
—
345080101
—
TX
01
—
744687
NURSE LICENSE #
TX
01
—
AP124942
APRN
TX
Enumeration date
01/11/2014
Last updated
03/07/2023
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