Provider Demographics
NPI:1770929937
Name:KOTTWITZ, JODI LYNN (FNP-C)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:LYNN
Last Name:KOTTWITZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 WAYNE ST
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-2255
Mailing Address - Country:US
Mailing Address - Phone:716-257-1254
Mailing Address - Fax:716-215-6170
Practice Address - Street 1:901 WAYNE ST
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-2255
Practice Address - Country:US
Practice Address - Phone:716-257-1254
Practice Address - Fax:716-215-6170
Is Sole Proprietor?:No
Enumeration Date:2013-05-15
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY604542163WH0200X
NY346557363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WH0200XNursing Service ProvidersRegistered NurseHome Health