Provider Demographics
NPI:1588682991
Name:RODE, JOANNE MARGARET (PA)
Entity Type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:MARGARET
Last Name:RODE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1024
Mailing Address - Street 2:
Mailing Address - City:LUCERNE
Mailing Address - State:CA
Mailing Address - Zip Code:95458-1024
Mailing Address - Country:US
Mailing Address - Phone:707-274-9101
Mailing Address - Fax:707-274-9192
Practice Address - Street 1:6302 13TH AVENUE
Practice Address - Street 2:
Practice Address - City:LUCERNE
Practice Address - State:CA
Practice Address - Zip Code:95458
Practice Address - Country:US
Practice Address - Phone:707-274-9101
Practice Address - Fax:707-274-9192
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16659363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ23121Medicare UPIN
CA0PA166590Medicare ID - Type Unspecified