Provider Demographics
NPI:1952382392
Name:ALDRICH, JODI LEA (ARNP)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:LEA
Last Name:ALDRICH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 LAKE DR STE 250
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-2504
Mailing Address - Country:US
Mailing Address - Phone:515-875-9290
Mailing Address - Fax:515-241-4162
Practice Address - Street 1:1221 PLEASANT ST STE 400
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1426
Practice Address - Country:US
Practice Address - Phone:515-875-9290
Practice Address - Fax:515-241-4162
Is Sole Proprietor?:No
Enumeration Date:2005-11-11
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA098045363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0434431Medicaid
IAP60196Medicare UPIN
IAI9258Medicare ID - Type Unspecified