Provider Demographics
NPI:1194948265
Name:BODNAR, NANCY A
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:A
Last Name:BODNAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2797 NC HIGHWAY 55
Mailing Address - Street 2:MINUTE CLINIC DIAGNOSTIC OF NORTH CAROLINA
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518
Mailing Address - Country:US
Mailing Address - Phone:866-389-2727
Mailing Address - Fax:401-652-9787
Practice Address - Street 1:2797 NC HIGHWAY 55
Practice Address - Street 2:MINUTE CLINIC DIAGNOSTIC OF NORTH CAROLINA
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:401-652-9787
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF330138363LF0000X
NC5007558363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY98V291Medicare ID - Type Unspecified
NYS72653Medicare UPIN