Provider Demographics
NPI:1689653974
Name:WESTOVER, JODI L (PA)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:L
Last Name:WESTOVER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:L
Other - Last Name:WELLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:1414 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-2415
Mailing Address - Country:US
Mailing Address - Phone:814-946-1955
Mailing Address - Fax:
Practice Address - Street 1:1414 9TH AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-2415
Practice Address - Country:US
Practice Address - Phone:814-946-1955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110001751363AM0700X
PAMA051001363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P75384Medicare UPIN
VAP00086537Medicare ID - Type UnspecifiedRAILROAD MEDICARE
VA002850S75Medicare ID - Type UnspecifiedTRAILBLAZER