Provider Demographics
NPI:1215392758
Name:REED, JODI (RN)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:REED
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:
Other - Last Name:JENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:7410 COUNTY ROAD K
Mailing Address - Street 2:SUITE 280
Mailing Address - City:SIREN
Mailing Address - State:WI
Mailing Address - Zip Code:54872-9070
Mailing Address - Country:US
Mailing Address - Phone:715-349-7600
Mailing Address - Fax:715-349-2140
Practice Address - Street 1:7410 COUNTY ROAD K
Practice Address - Street 2:SUITE 280
Practice Address - City:SIREN
Practice Address - State:WI
Practice Address - Zip Code:54872-9070
Practice Address - Country:US
Practice Address - Phone:715-349-7600
Practice Address - Fax:715-349-2140
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-29
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI192981-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI192981-30OtherLICENSE