Provider Demographics
NPI:1235440173
Name:DEBROUX, JODI L (APNP)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:L
Last Name:DEBROUX
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 ROSS AVE STE 14
Mailing Address - Street 2:
Mailing Address - City:SCHOFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54476-6104
Mailing Address - Country:US
Mailing Address - Phone:715-539-8725
Mailing Address - Fax:
Practice Address - Street 1:320 ROSS AVE STE 14
Practice Address - Street 2:
Practice Address - City:SCHOFIELD
Practice Address - State:WI
Practice Address - Zip Code:54476-6104
Practice Address - Country:US
Practice Address - Phone:715-359-8725
Practice Address - Fax:715-355-7966
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4070363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner