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Individual

JOHANNA CONGLETON BODINE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
CNM

Contact information

Practice address
411 N WASHINGTON AVE STE 2700, DALLAS, TX 75246-1735
(214) 975-3937
Mailing address
411 N WASHINGTON AVE STE 2700, DALLAS, TX 75246-1735
(214) 975-3937
(469) 309-7787

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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