Alice Rose Bodlak, RN

Primary specialty

Case Management Registered NurseTaxonomy code 163WC0400X

License

RN484275 Issued in CA

Practice address

2191 Johnson Ave
San Luis Obispo, CA 93401-4534

Phone

(805) 781-1744

NPI assigned

Nov 14, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1194998400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1194998400000",
    "number": "1164603569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2191 JOHNSON AVE",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934014534",
            "telephone_number": "805-781-1744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2191 JOHNSON AVE",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934014534",
            "telephone_number": "805-781-1744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BODLAK",
        "first_name": "ALICE",
        "middle_name": "ROSE",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-11-14",
        "last_updated": "2007-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC0400X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Case Management",
            "state": "CA",
            "license": "RN484275",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bryce Jeffrey Blue, O.D.
• Daphne L. Boatright, RN MED
• Meghan Kathleen Boaz Alvarez, MFT
• Anna Bobba, M.D.
• Mark C Bocchicchio, MD, FACC
• Brian Bolenbaugh
• Olivia Zoleta Boles
• Ann L Bollay, MD
• Callie Rose Boller
• Jill Bolster-White

• Case Management Registered Nurse in San Luis Obispo, CA
• Providers in San Luis Obispo, CA by specialty
• Case Management Registered Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.