Provider Demographics
NPI:1275229908
Name:DIMINNO, JODIE PATRICIA
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:PATRICIA
Last Name:DIMINNO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 ZEHNDNER AVE APT A
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-5465
Mailing Address - Country:US
Mailing Address - Phone:707-616-0930
Mailing Address - Fax:
Practice Address - Street 1:1815 ZEHNDNER AVE APT A
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-5465
Practice Address - Country:US
Practice Address - Phone:707-616-0930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-14
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula