Provider Demographics
NPI:1205143542
Name:DAILEY, JODI ANN (APNP)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:ANN
Last Name:DAILEY
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N2665 COUNTY ROAD QQ
Mailing Address - Street 2:
Mailing Address - City:KING
Mailing Address - State:WI
Mailing Address - Zip Code:54946-0600
Mailing Address - Country:US
Mailing Address - Phone:715-256-3281
Mailing Address - Fax:
Practice Address - Street 1:N2665 COUNTY ROAD QQ
Practice Address - Street 2:
Practice Address - City:KING
Practice Address - State:WI
Practice Address - Zip Code:54946-0600
Practice Address - Country:US
Practice Address - Phone:715-256-3281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2695-033363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health