Individual
MABEL AMELIA BODELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
MD60462328
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1659418135
—
WA
01
—
P01604998
RR MEDICARE WVH
WA
Enumeration date
01/31/2007
Last updated
06/09/2022
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