Provider Demographics
NPI:1811258270
Name:AYDELOTTE, JOSHUA JOHN (RN-BSN)
Entity type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:JOHN
Last Name:AYDELOTTE
Suffix:
Gender:M
Credentials:RN-BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 ALYDAR DR
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-4755
Mailing Address - Country:US
Mailing Address - Phone:319-491-4035
Mailing Address - Fax:
Practice Address - Street 1:191 ALYDAR DR
Practice Address - Street 2:
Practice Address - City:NORTH LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52317-4755
Practice Address - Country:US
Practice Address - Phone:319-491-4035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-01
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA127214163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse