Provider Demographics
NPI:1346985959
Name:BODEMAN, JESSICA (FNP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:BODEMAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10350 HALIGUS RD STE A
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-9545
Mailing Address - Country:US
Mailing Address - Phone:815-455-6100
Mailing Address - Fax:847-802-7162
Practice Address - Street 1:10350 HALIGUS RD STE A
Practice Address - Street 2:
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142-9545
Practice Address - Country:US
Practice Address - Phone:815-455-6100
Practice Address - Fax:847-802-7162
Is Sole Proprietor?:No
Enumeration Date:2022-04-28
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209024428363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily