Provider Demographics
NPI:1629170618
Name:JONDRO, JODY L (CRNA)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:L
Last Name:JONDRO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JODY
Other - Middle Name:L
Other - Last Name:SHOWALTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:4227 LINCOLNSHIRE DRIVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-2157
Mailing Address - Country:US
Mailing Address - Phone:618-242-2317
Mailing Address - Fax:618-242-9710
Practice Address - Street 1:605 N 12TH ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-2857
Practice Address - Country:US
Practice Address - Phone:618-241-1108
Practice Address - Fax:618-241-3805
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR54232367500000X
IL209004625367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
K04305Medicare ID - Type Unspecified