Provider Demographics
NPI:1669774006
Name:NIEMI, JODI A (RN, MSN, FNP-BC, APN)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:A
Last Name:NIEMI
Suffix:
Gender:F
Credentials:RN, MSN, FNP-BC, APN
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:15735 W US HIGHWAY 63
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:WI
Mailing Address - Zip Code:54843-6475
Mailing Address - Country:US
Mailing Address - Phone:888-834-4551
Mailing Address - Fax:715-598-4881
Practice Address - Street 1:7665 US HIGHWAY 2
Practice Address - Street 2:
Practice Address - City:IRON RIVER
Practice Address - State:WI
Practice Address - Zip Code:54847-4690
Practice Address - Country:US
Practice Address - Phone:715-372-5001
Practice Address - Fax:715-372-5011
Is Sole Proprietor?:No
Enumeration Date:2010-11-17
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI4262-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1669774006Medicaid
WI1669774006Medicaid