Provider Demographics
NPI:1487683637
Name:DODD, RESCHA (NP)
Entity Type:Individual
Prefix:
First Name:RESCHA
Middle Name:
Last Name:DODD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:IOLA
Mailing Address - State:WI
Mailing Address - Zip Code:54945-9685
Mailing Address - Country:US
Mailing Address - Phone:715-445-4801
Mailing Address - Fax:715-445-4805
Practice Address - Street 1:205 S MAIN ST
Practice Address - Street 2:
Practice Address - City:IOLA
Practice Address - State:WI
Practice Address - Zip Code:54945-9685
Practice Address - Country:US
Practice Address - Phone:715-445-4801
Practice Address - Fax:715-445-4805
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2015-033363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P58134Medicare UPIN