# JOHANNA CONGLETON BODINE

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1184046096
- **Gender:** F
- **Credential:** CNM

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 367A00000X | Advanced Practice Midwife | CNM1795 | TX | Yes |

## Other

- **Enumeration date:** 01/11/2014
- **Last updated:** 03/07/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 15228 | RX AUTH \# | TX |
| 05 | — | 345080101 | — | TX |
| 01 | — | 744687 | NURSE LICENSE \# | TX |
| 01 | — | AP124942 | APRN | TX |