Provider Demographics
NPI:1063548477
Name:BODNER, CAROLINE CRUZ (ACNP)
Entity type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:CRUZ
Last Name:BODNER
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:768 COLLEGE PKWY
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-1929
Mailing Address - Country:US
Mailing Address - Phone:301-424-5967
Mailing Address - Fax:
Practice Address - Street 1:8901 WISCONSIN AVENUE CARDIOLOGY BUILDING 9
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-6367
Practice Address - Country:US
Practice Address - Phone:301-319-2797
Practice Address - Fax:301-295-6638
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR136960363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care