Provider Demographics
NPI:1942653811
Name:FIELDS, JODI (APNP-C)
Entity Type:Individual
Prefix:MISS
First Name:JODI
Middle Name:
Last Name:FIELDS
Suffix:
Gender:F
Credentials:APNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 W LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:WAUPUN
Mailing Address - State:WI
Mailing Address - Zip Code:53963-1949
Mailing Address - Country:US
Mailing Address - Phone:920-324-6489
Mailing Address - Fax:920-324-6288
Practice Address - Street 1:1 W LINCOLN ST
Practice Address - Street 2:
Practice Address - City:WAUPUN
Practice Address - State:WI
Practice Address - Zip Code:53963-1949
Practice Address - Country:US
Practice Address - Phone:920-324-6489
Practice Address - Fax:920-324-6288
Is Sole Proprietor?:No
Enumeration Date:2016-07-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7052-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily