Provider Demographics
NPI:1588956510
Name:BODUNGEN, ANGELA LEE
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:LEE
Last Name:BODUNGEN
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 1:1805 METAIRIE AVE
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005-3860
Mailing Address - Country:US
Mailing Address - Phone:504-835-6467
Mailing Address - Fax:504-835-9498
Practice Address - Street 1:1805 METAIRIE AVE
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005-3860
Practice Address - Country:US
Practice Address - Phone:504-835-6467
Practice Address - Fax:504-835-9498
Is Sole Proprietor?:No
Enumeration Date:2011-05-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA18609183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA222ROSEMedicaid