Individual
PEGGY BODELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10467 93RD AVE N, MAPLE GROVE, MN 55369-4112
(651) 488-4655
Mailing address
10467 93RD AVE N, MAPLE GROVE, MN 55369-4112
(651) 488-4655
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
1435289
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1144260589
—
MN
Enumeration date
07/07/2022
Last updated
07/07/2022
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