Provider Demographics
NPI:1609103977
Name:JUNG, JODI L (CNP)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:L
Last Name:JUNG
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 49
Mailing Address - Street 2:810 3RD ST
Mailing Address - City:DE SMET
Mailing Address - State:SD
Mailing Address - Zip Code:57231-0001
Mailing Address - Country:US
Mailing Address - Phone:605-854-3455
Mailing Address - Fax:605-854-9952
Practice Address - Street 1:810 3RD ST
Practice Address - Street 2:
Practice Address - City:DESMET
Practice Address - State:SD
Practice Address - Zip Code:57231-0001
Practice Address - Country:US
Practice Address - Phone:605-854-3455
Practice Address - Fax:605-854-9952
Is Sole Proprietor?:No
Enumeration Date:2009-11-06
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000580363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily