Provider Demographics
NPI:1346356383
Name:JODOIN, MICHELE (PA)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:JODOIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 ROWLAND BLVD
Mailing Address - Street 2:215
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945
Mailing Address - Country:US
Mailing Address - Phone:415-897-5171
Mailing Address - Fax:415-892-1611
Practice Address - Street 1:165 ROWLAND BLVD
Practice Address - Street 2:215
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945
Practice Address - Country:US
Practice Address - Phone:415-897-5171
Practice Address - Fax:415-892-1611
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13706363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant