Provider Demographics
NPI:1619019452
Name:DANTER, JODI L (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:L
Last Name:DANTER
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:L
Other - Last Name:REITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5955 ZEAMER AVE
Mailing Address - Street 2:673 MED GROUP/SGCUB
Mailing Address - City:ELMENDORF AFB
Mailing Address - State:AK
Mailing Address - Zip Code:99506-3702
Mailing Address - Country:US
Mailing Address - Phone:907-580-1571
Mailing Address - Fax:907-580-1575
Practice Address - Street 1:5955 ZEAMER AVE
Practice Address - Street 2:673 MED GROUP/SGCUB
Practice Address - City:ELMENDORF AFB
Practice Address - State:AK
Practice Address - Zip Code:99506-3702
Practice Address - Country:US
Practice Address - Phone:907-580-1571
Practice Address - Fax:907-580-1575
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1076358363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant