Provider Demographics
NPI:1407966898
Name:SPAHR, JODI O (CPNP)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:O
Last Name:SPAHR
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:A
Other - Last Name:O'KEEFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3610 MICHELLE WITMER MEMORIAL DR #100
Mailing Address - Street 2:SOUTHWEST PEDIATRICS
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151
Mailing Address - Country:US
Mailing Address - Phone:262-789-6020
Mailing Address - Fax:
Practice Address - Street 1:4855 S MOORLAND RD STE 250
Practice Address - Street 2:
Practice Address - City:NEW BERLIN
Practice Address - State:WI
Practice Address - Zip Code:53151-7494
Practice Address - Country:US
Practice Address - Phone:262-789-6020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4166-33363LP0200X
MNR 175483-4363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN298482100Medicaid
MN298482100Medicaid
MN500003488Medicare ID - Type Unspecified