Provider Demographics
NPI:1174919724
Name:BODNAR, TAYLOR (APN)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:BODNAR
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:K
Other - Last Name:LOUDERMILK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 155
Mailing Address - Street 2:
Mailing Address - City:CHRISTOPHER
Mailing Address - State:IL
Mailing Address - Zip Code:62822-0155
Mailing Address - Country:US
Mailing Address - Phone:618-724-1624
Mailing Address - Fax:618-724-4628
Practice Address - Street 1:33 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:IL
Practice Address - Zip Code:62806-1006
Practice Address - Country:US
Practice Address - Phone:618-445-2287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-10
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209020334363LP0200X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics