Provider Demographics
NPI:1346894714
Name:BOND, JODI E (NP-C)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:E
Last Name:BOND
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20660 N 40TH ST UNIT 2114
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-7319
Mailing Address - Country:US
Mailing Address - Phone:317-797-4518
Mailing Address - Fax:
Practice Address - Street 1:20660 N 40TH ST UNIT 2114
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-7319
Practice Address - Country:US
Practice Address - Phone:317-797-4518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ229836363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily