Provider Demographics
NPI:1447902234
Name:BODNAR, HAYLEE (RN)
Entity type:Individual
Prefix:
First Name:HAYLEE
Middle Name:
Last Name:BODNAR
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 1:22819 MCCOURTNEY RD
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95949-7676
Mailing Address - Country:US
Mailing Address - Phone:530-301-6286
Mailing Address - Fax:
Practice Address - Street 1:22819 MCCOURTNEY RD
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95949-7676
Practice Address - Country:US
Practice Address - Phone:530-301-6286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-22
Last Update Date:2022-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR055545163WE0003X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WE0003XNursing Service ProvidersRegistered NurseEmergency