Individual
TAYLOR BODEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MMS, RD, PA-C
Contact information
Practice address
259 E ERIE ST STE 2020, CHICAGO, IL 60611-2994
(312) 695-6647
(312) 695-0044
Mailing address
259 E ERIE ST STE 2020, CHICAGO, IL 60611-2994
(312) 695-6647
(312) 695-0044
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300041213
—
IN
Enumeration date
05/19/2020
Last updated
11/21/2024
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