Provider Demographics
NPI:1013907179
Name:RIPKA, JODI (APRN)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:RIPKA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 LOWER WESTFIELD RD STE 1
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-2676
Mailing Address - Country:US
Mailing Address - Phone:413-536-2393
Mailing Address - Fax:413-536-1087
Practice Address - Street 1:150 LOWER WESTFIELD RD STE 1
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-2676
Practice Address - Country:US
Practice Address - Phone:413-536-2393
Practice Address - Fax:413-536-1087
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN217510363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTQ25722Medicare UPIN
CT500001332Medicare ID - Type Unspecified
CT004245610Medicaid