Provider Demographics
NPI:1235761891
Name:BODMER, AMBER
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:BODMER
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 1:260 FOOTHILL DR
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45309-1515
Mailing Address - Country:US
Mailing Address - Phone:937-477-6897
Mailing Address - Fax:
Practice Address - Street 1:260 FOOTHILL DR
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:OH
Practice Address - Zip Code:45309-1515
Practice Address - Country:US
Practice Address - Phone:937-477-6897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-11
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker