Provider Demographics
NPI:1477784593
Name:HARGIS, JODI L (RN, CCRN)
Entity Type:Individual
Prefix:MS
First Name:JODI
Middle Name:L
Last Name:HARGIS
Suffix:
Gender:F
Credentials:RN, CCRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:MONTREAL
Mailing Address - State:WI
Mailing Address - Zip Code:54550-9733
Mailing Address - Country:US
Mailing Address - Phone:715-561-2363
Mailing Address - Fax:
Practice Address - Street 1:114 WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:MONTREAL
Practice Address - State:WI
Practice Address - Zip Code:54550-9733
Practice Address - Country:US
Practice Address - Phone:715-561-2363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI107731163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse