Provider Demographics
NPI:1740393149
Name:WOZNIAK, JODY K (DO)
Entity Type:Individual
Prefix:DR
First Name:JODY
Middle Name:K
Last Name:WOZNIAK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1772
Mailing Address - Street 2:
Mailing Address - City:KEALAKEKUA
Mailing Address - State:HI
Mailing Address - Zip Code:96750
Mailing Address - Country:US
Mailing Address - Phone:330-608-2364
Mailing Address - Fax:
Practice Address - Street 1:79-1019 HAEKAPILA STREET
Practice Address - Street 2:KONA COMMUNITY HOSPITAL
Practice Address - City:KEALAKEKUA
Practice Address - State:HI
Practice Address - Zip Code:96750
Practice Address - Country:US
Practice Address - Phone:808-322-4413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34003807207P00000X
HI1359207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0741424Medicaid
OHE54226Medicare UPIN
OHWO0637395Medicare ID - Type Unspecified