Provider Demographics
NPI:1801508601
Name:ANTON, JODIEANNE ELIZABETH (CPM)
Entity type:Individual
Prefix:MRS
First Name:JODIEANNE
Middle Name:ELIZABETH
Last Name:ANTON
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 E HOMESTEAD ST
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-1730
Mailing Address - Country:US
Mailing Address - Phone:216-280-7148
Mailing Address - Fax:
Practice Address - Street 1:113 E HOMESTEAD ST
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-1730
Practice Address - Country:US
Practice Address - Phone:216-280-7148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-23
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CPM22030004176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife