Provider Demographics
NPI:1619663671
Name:UNDERWOOD, JODI MICHELE
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:MICHELE
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25271-1529
Mailing Address - Country:US
Mailing Address - Phone:681-274-1820
Mailing Address - Fax:
Practice Address - Street 1:333 3RD AVE
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:WV
Practice Address - Zip Code:25271-1529
Practice Address - Country:US
Practice Address - Phone:681-274-1820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant