Provider Demographics
NPI:1518444512
Name:SMITH, JODI JANE (ARNP)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:JANE
Last Name:SMITH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1223 S GEAR AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:WEST BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52655-1685
Mailing Address - Country:US
Mailing Address - Phone:319-753-5177
Mailing Address - Fax:319-753-0893
Practice Address - Street 1:1223 S GEAR AVE STE 108
Practice Address - Street 2:
Practice Address - City:WEST BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655-1685
Practice Address - Country:US
Practice Address - Phone:319-753-5177
Practice Address - Fax:319-753-0893
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209021846363L00000X
IAA138731363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner