Provider Demographics
NPI:1023465267
Name:BANGASSER, JODI (ARNP)
Entity type:Individual
Prefix:MRS
First Name:JODI
Middle Name:
Last Name:BANGASSER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:ALLISON
Mailing Address - State:IA
Mailing Address - Zip Code:50602-7801
Mailing Address - Country:US
Mailing Address - Phone:641-425-4346
Mailing Address - Fax:319-267-2234
Practice Address - Street 1:312 9TH ST SW
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:IA
Practice Address - Zip Code:50677-2929
Practice Address - Country:US
Practice Address - Phone:319-483-1365
Practice Address - Fax:319-352-3992
Is Sole Proprietor?:No
Enumeration Date:2016-05-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAH095679363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care