Provider Demographics
NPI:1720219298
Name:NJIE, JODY LINN (LPN)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:LINN
Last Name:NJIE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4087 WINTERGREEN BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43230-1070
Mailing Address - Country:US
Mailing Address - Phone:614-352-3415
Mailing Address - Fax:
Practice Address - Street 1:4087 WINTERGREEN BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43230-1070
Practice Address - Country:US
Practice Address - Phone:614-352-3415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-01
Last Update Date:2009-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.118015 IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse