Provider Demographics
NPI:1952786717
Name:BOHL, JODI MARIE (CPNP)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:MARIE
Last Name:BOHL
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:
Other - Last Name:STALMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1446 W SCHOOL ST
Mailing Address - Street 2:UNIT 2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-2120
Mailing Address - Country:US
Mailing Address - Phone:630-890-8802
Mailing Address - Fax:
Practice Address - Street 1:225 E CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2991
Practice Address - Country:US
Practice Address - Phone:123-227-4000
Practice Address - Fax:312-227-9384
Is Sole Proprietor?:No
Enumeration Date:2015-07-22
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209011394363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics