Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mary Louise Bodewes, PAC

Individual provider Physician Assistant · NPI 1659476398

Mary Louise Bodewes, PAC is a Physician Assistant in Farmington, New Mexico. Qualified in 1995, 31 years ago. Practices with San Juan Regional Medical Center, Inc, a 231-clinician group, works from 3 locations and accepts Medicare assignment. Licensed in Colorado, New Mexico and Wisconsin.

Years since qualifying
31
Licensed in
CO, NM, WI
In the registry since
2006
Specialties on file
3
What do these letters mean?
PAC — Physician Assistant, Certified
A physician assistant holding current national certification; usually written PA-C.

See every abbreviation used in this directory →

Practice location Address checks out

630 W Maple St
Farmington, NM 87401-6113
Phone: (505) 609-6349
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • 1485 Florida Rd Ste 103a, Durango, CO 81301-6873 — (970) 444-0260
  • 2727 Plaza Drive, Wausau, WI 54401 — (715) 358-1184

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA2021-0130 (NM)
Physician Assistant Taxonomy 363A00000X · Licence 988 (WI)
Physician Assistant Taxonomy 363A00000X · Licence PA.005343 (CO)

Record details

NPI number1659476398
Entity typeIndividual (Type 1)
GenderFemale
Credentials PAC
Sole proprietorNo
NPI enumeratedSeptember 14, 2006
Last updated in NPPESNovember 8, 2024
Certification dateNovember 8, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 1995 (31 years in practice)
Group practice San Juan Regional Medical Center, Inc. — 231 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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