Individual
MRS. STACY MARIE BODLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
420 NE MASON ST, PORTLAND, OR 97211-3479
(506) 546-9421
Mailing address
14302 BRITTANY TER, OREGON CITY, OR 97045-7156
(503) 546-9421
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
200730013LPN
OR
Other
Enumeration date
04/20/2016
Last updated
04/20/2016
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