Provider Demographics
NPI:1275817165
Name:ACKLEY, JODI LOUISE
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:LOUISE
Last Name:ACKLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 FAUCETTE CT
Mailing Address - Street 2:
Mailing Address - City:MC KEAN
Mailing Address - State:PA
Mailing Address - Zip Code:16426-1316
Mailing Address - Country:US
Mailing Address - Phone:814-449-8074
Mailing Address - Fax:
Practice Address - Street 1:8 FAUCETTE CT
Practice Address - Street 2:
Practice Address - City:MC KEAN
Practice Address - State:PA
Practice Address - Zip Code:16426-1316
Practice Address - Country:US
Practice Address - Phone:814-449-8074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN280592164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse