Provider Demographics
NPI:1568296663
Name:BODARY, DANA KATHERINE (IBCLC)
Entity type:Individual
Prefix:MISS
First Name:DANA
Middle Name:KATHERINE
Last Name:BODARY
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 12TH AVE NW APT 1
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-6208
Mailing Address - Country:US
Mailing Address - Phone:734-775-4854
Mailing Address - Fax:
Practice Address - Street 1:15 12TH AVE NW APT 1
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-6208
Practice Address - Country:US
Practice Address - Phone:734-775-4854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-314157174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN