Provider Demographics
NPI:1124038344
Name:HOLSCHLAG, JODI L (CRNA)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:L
Last Name:HOLSCHLAG
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:L
Other - Last Name:JOEBGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 1ST ST SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55905-0001
Mailing Address - Country:US
Mailing Address - Phone:507-284-2511
Mailing Address - Fax:
Practice Address - Street 1:200 1ST ST SW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55905-0001
Practice Address - Country:US
Practice Address - Phone:507-284-2511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 149365-8367500000X
MN946367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAENROLLEDMedicaid
SDENROLLEDMedicaid
MN842667100Medicaid
WIENROLLEDMedicaid
MNP00428377OtherRAILROAD MEDICARE
MN842667100Medicaid