Provider Demographics
NPI:1720318553
Name:WOJCIECHOWSKI, JODI ANN (FNP- BC)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:ANN
Last Name:WOJCIECHOWSKI
Suffix:
Gender:F
Credentials:FNP- BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4672 HILL ST
Mailing Address - Street 2:
Mailing Address - City:CASS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48726-1072
Mailing Address - Country:US
Mailing Address - Phone:989-872-8202
Mailing Address - Fax:989-872-1245
Practice Address - Street 1:1003 WOODSIDE AVE
Practice Address - Street 2:
Practice Address - City:ESSEXVILLE
Practice Address - State:MI
Practice Address - Zip Code:48732-1234
Practice Address - Country:US
Practice Address - Phone:989-892-7722
Practice Address - Fax:989-892-7455
Is Sole Proprietor?:No
Enumeration Date:2009-12-29
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704185313363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704185313OtherSTATE LIC NUMBER
MIZ96017101Medicare PIN