Provider Demographics
NPI:1972050615
Name:TRUJILLO, JODI R (PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:JODI
Middle Name:R
Last Name:TRUJILLO
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:R
Other - Last Name:LINDEMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP-BC
Mailing Address - Street 1:37 S BRIARWOOD PL
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-1803
Mailing Address - Country:US
Mailing Address - Phone:719-431-1615
Mailing Address - Fax:
Practice Address - Street 1:37 S BRIARWOOD PL
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005-1803
Practice Address - Country:US
Practice Address - Phone:719-431-1615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0165581363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health