Provider Demographics
NPI:1629127873
Name:PAPKE, JODI (BS)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:PAPKE
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14636 GAYLORD ST
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80602-7376
Mailing Address - Country:US
Mailing Address - Phone:720-334-2821
Mailing Address - Fax:303-474-7397
Practice Address - Street 1:14636 GAYLORD ST
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80602-7376
Practice Address - Country:US
Practice Address - Phone:720-334-2821
Practice Address - Fax:303-474-7397
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05523788Medicaid