Provider Demographics
NPI:1932723897
Name:BODE, KATHRYN L (PHD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:L
Last Name:BODE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8501 RANCHO DEL CERRO DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-2076
Mailing Address - Country:US
Mailing Address - Phone:505-480-3290
Mailing Address - Fax:505-207-1372
Practice Address - Street 1:8501 RANCHO DEL CERRO DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-2076
Practice Address - Country:US
Practice Address - Phone:505-480-3290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider