Provider Demographics
NPI:1538414776
Name:BODUS, MARSHA E (RN)
Entity type:Individual
Prefix:
First Name:MARSHA
Middle Name:E
Last Name:BODUS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15771 GREEN RD
Mailing Address - Street 2:
Mailing Address - City:LACHINE
Mailing Address - State:MI
Mailing Address - Zip Code:49753-9799
Mailing Address - Country:US
Mailing Address - Phone:989-278-0641
Mailing Address - Fax:
Practice Address - Street 1:201 ROUTE 34 SOUTH
Practice Address - Street 2:BLDG C-3
Practice Address - City:COLTS NECK
Practice Address - State:NJ
Practice Address - Zip Code:07722
Practice Address - Country:US
Practice Address - Phone:732-866-2303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704262370163W00000X, 163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical