Provider Demographics
NPI:1942463906
Name:MEDEIROS, JODI ELIZABETH (JODI MEDEIROS LPN)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:ELIZABETH
Last Name:MEDEIROS
Suffix:
Gender:F
Credentials:JODI MEDEIROS LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 COPELAND DRIVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-1248
Mailing Address - Country:US
Mailing Address - Phone:508-339-4416
Mailing Address - Fax:
Practice Address - Street 1:181 COPELAND DR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:MA
Practice Address - Zip Code:02048-1248
Practice Address - Country:US
Practice Address - Phone:508-339-4416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA39825164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse