Provider Demographics
NPI:1811441942
Name:D'AVIGNON, JODI L (RN)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:L
Last Name:D'AVIGNON
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 1:335 VINEYARD RD NW
Mailing Address - Street 2:
Mailing Address - City:LOS RANCHOS
Mailing Address - State:NM
Mailing Address - Zip Code:87107-5805
Mailing Address - Country:US
Mailing Address - Phone:505-803-3397
Mailing Address - Fax:
Practice Address - Street 1:127 HAGON RD
Practice Address - Street 2:
Practice Address - City:ALGODONES
Practice Address - State:NM
Practice Address - Zip Code:87001-8087
Practice Address - Country:US
Practice Address - Phone:505-771-9922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-05
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR26560163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse