Individual
CAROL ANN BODMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1425 PATRICIAN DR, LAKE HAVASU CITY, AZ 86404-1917
(928) 505-6911
(928) 505-6991
Mailing address
2200 HAVASUPAI BLVD, LAKE HAVASU CITY, AZ 86403-3122
(928) 505-6911
(928) 505-6991
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
RN086484
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
566119
—
AZ
Enumeration date
06/27/2007
Last updated
07/09/2007
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