Provider Demographics
NPI:1841542826
Name:SILBAUGH, JODIE ANN (RN)
Entity type:Individual
Prefix:
First Name:JODIE
Middle Name:ANN
Last Name:SILBAUGH
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 1:1502 W COURT ST
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53548-3502
Mailing Address - Country:US
Mailing Address - Phone:608-755-0722
Mailing Address - Fax:
Practice Address - Street 1:1502 W COURT ST
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-3502
Practice Address - Country:US
Practice Address - Phone:608-755-0722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI120401-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse