Individual
STACY L BODEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3200 PLEASANT VALLEY RD, WEST BEND, WI 53095-9274
(262) 334-3451
(262) 306-2964
Mailing address
1700 W PARADISE DR, WEST BEND, WI 53095-9795
(262) 334-3451
(262) 306-2964
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
144166
WI
Other
Enumeration date
08/11/2009
Last updated
08/11/2009
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