Provider Demographics
NPI:1720485634
Name:STAPLETON, JODI RENEA (RN)
Entity Type:Individual
Prefix:MRS
First Name:JODI
Middle Name:RENEA
Last Name:STAPLETON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1544 VAUGHN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WEST UNION
Mailing Address - State:OH
Mailing Address - Zip Code:45693-9617
Mailing Address - Country:US
Mailing Address - Phone:937-544-8176
Mailing Address - Fax:
Practice Address - Street 1:1544 VAUGHN RIDGE RD
Practice Address - Street 2:
Practice Address - City:WEST UNION
Practice Address - State:OH
Practice Address - Zip Code:45693-9617
Practice Address - Country:US
Practice Address - Phone:937-544-8176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-21
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 294109163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse