Provider Demographics
NPI:1295851707
Name:UNDERWOOD, JODY R (ARNP)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:R
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 365
Mailing Address - Street 2:5220 GAP RD
Mailing Address - City:OUTLOOK
Mailing Address - State:WA
Mailing Address - Zip Code:98938-0365
Mailing Address - Country:US
Mailing Address - Phone:509-837-2804
Mailing Address - Fax:509-373-8370
Practice Address - Street 1:246 N MISSION ST
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2004
Practice Address - Country:US
Practice Address - Phone:509-373-8200
Practice Address - Fax:509-373-8370
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004205363LX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health