Provider Demographics
NPI:1073036141
Name:CLAYTOR, JODY LYN (RN)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:LYN
Last Name:CLAYTOR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JODY
Other - Middle Name:LYN
Other - Last Name:KITZMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3180 RACQUET CLUB DR STE D
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-4797
Mailing Address - Country:US
Mailing Address - Phone:231-943-2552
Mailing Address - Fax:231-943-2555
Practice Address - Street 1:3180 RACQUET CLUB DR STE D
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-4797
Practice Address - Country:US
Practice Address - Phone:231-943-2552
Practice Address - Fax:231-943-2555
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704319525163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse