Individual
RENEE L BODARY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
933 NEWBURY ST, FOND DU LAC, WI 54971-1730
(920) 748-0430
Mailing address
420 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 926-8340
(920) 926-8370
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
3213-033
WI
363LF0000X
Family Nurse Practitioner
Primary
3213-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
142231-030
RN
WI
05
—
36048500
—
WI
Enumeration date
10/02/2007
Last updated
03/21/2012
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