Provider Demographics
NPI:1518062595
Name:CALABRO, JODI A (CRNP)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:A
Last Name:CALABRO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 HIGHWAY 315
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-6852
Mailing Address - Country:US
Mailing Address - Phone:570-823-8896
Mailing Address - Fax:570-823-1291
Practice Address - Street 1:1130 HIGHWAY 315
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-6852
Practice Address - Country:US
Practice Address - Phone:570-823-8896
Practice Address - Fax:570-823-1291
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP005924H363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
928312OtherBLUE SHIELD
050569Medicare ID - Type Unspecified
P38876Medicare UPIN