1669774006 NPI number — JODI A NIEMI RN, MSN, FNP-BC, APN

Table of content: JODI A NIEMI RN, MSN, FNP-BC, APN (NPI 1669774006)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669774006 NPI number — JODI A NIEMI RN, MSN, FNP-BC, APN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NIEMI
Provider First Name:
JODI
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN, MSN, FNP-BC, APN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669774006
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15735 W US HIGHWAY 63
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAYWARD
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54843-6475
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-834-4551
Provider Business Mailing Address Fax Number:
715-598-4881

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7665 US HIGHWAY 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IRON RIVER
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54847-4690
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-372-5001
Provider Business Practice Location Address Fax Number:
715-372-5011
Provider Enumeration Date:
11/17/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  4262-33 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1669774006 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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