Provider Demographics
NPI:1811123573
Name:MISEGADES, JODI LYNN (RN PHN)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:LYNN
Last Name:MISEGADES
Suffix:
Gender:F
Credentials:RN PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 99
Mailing Address - Street 2:
Mailing Address - City:NEW YORK MILLS
Mailing Address - State:MN
Mailing Address - Zip Code:56567-0099
Mailing Address - Country:US
Mailing Address - Phone:218-385-5508
Mailing Address - Fax:
Practice Address - Street 1:118 MAIN AVENUE NORTH
Practice Address - Street 2:
Practice Address - City:NEW YORK MILLS
Practice Address - State:MN
Practice Address - Zip Code:56567-0099
Practice Address - Country:US
Practice Address - Phone:218-385-5508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-08
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR152074-1163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health