Provider Demographics
NPI:1093721185
Name:DOBSLAW, JODI L (CRNP)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:L
Last Name:DOBSLAW
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:L
Other - Last Name:LINDSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 858
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-0858
Mailing Address - Country:US
Mailing Address - Phone:800-243-1455
Mailing Address - Fax:
Practice Address - Street 1:500 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2360
Practice Address - Country:US
Practice Address - Phone:800-243-1455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP009114363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00353623OtherRAILROAD MEDICARE
PA50063463OtherCAPITAL BLUE CROSS
PA50063463OtherKEYSTONE HEALTH PLANS
PA50063463OtherKEYSTONE HEALTH PLANS
103926F9LMedicare ID - Type Unspecified