Individual
MS. JOHNNA L BODENSTAB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
17611 EAST 24 HIGHWAY, SUITE 200, INDEPENDENCE, MO 64055-1823
(816) 257-7787
(816) 257-6948
Mailing address
17611 EAST 24 HIGHWAY, SUITE 200, INDEPENDENCE, MO 64056-1823
(816) 257-7787
(816) 257-6948
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
100447
MO
363LF0000X
Family Nurse Practitioner
Primary
100447
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000C892
MEDICARE NUMBER
MO
Enumeration date
11/03/2005
Last updated
08/20/2007
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