Provider Demographics
NPI:1447258744
Name:BODET, COLLEEN FRANTZ (MN, RN, FNP)
Entity type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:FRANTZ
Last Name:BODET
Suffix:
Gender:F
Credentials:MN, RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1921 PENISTON ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-5355
Mailing Address - Country:US
Mailing Address - Phone:504-897-1614
Mailing Address - Fax:504-309-8115
Practice Address - Street 1:5625 LOYOLA AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-5014
Practice Address - Country:US
Practice Address - Phone:504-359-1131
Practice Address - Fax:504-861-1780
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN056352 AP04063363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1153842Medicaid
LA4C570F669Medicare PIN
LA1153842Medicaid
LAP80129Medicare UPIN