Provider Demographics
NPI:1225278609
Name:STOWATER-GOODRICH, JODI L (PA)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:L
Last Name:STOWATER-GOODRICH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1288 VALLEY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-5245
Mailing Address - Country:US
Mailing Address - Phone:712-328-8800
Mailing Address - Fax:712-328-8461
Practice Address - Street 1:1288 VALLEY VIEW DR
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-5245
Practice Address - Country:US
Practice Address - Phone:712-328-8800
Practice Address - Fax:712-328-8461
Is Sole Proprietor?:No
Enumeration Date:2009-02-25
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE1430363AM0700X
IA002206363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical