Bodewes, Mary Louise

Bodewes, Mary Louise is an individual health care provider with primary practice located at 630 W Maple St , Farmington NM 87401-6113. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Bodewes, Mary Louise can be contacted via phone (505) 609-6349.

Contact Information

Primary practice address
630 W Maple St Farmington NM 87401-6113
Phone: (505) 609-6349
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 988 Wisconsin
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA.005343 Colorado
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA2021-0130 New Mexico

Profile Details

NPI number 1659476398
LBN Legal business name Bodewes, Mary Louise
Credentials PAC
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 14th, 2006
Last updated May 7th, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1659476398 NPPES
Wisconsin MEDICAID 42971200

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