Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | R77231 | AZ |
N | 207VG0400X | Gynecologist | R77231 | AZ |
NPI | 1154974848 |
---|---|
Provider Name | Andreanne M Jodoin |
First Address | Tempe, AZ 85281-2794 |
Second Address | Phoenix, AZ 85016-7710 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2019 |
Last Update Date | 22/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10654119 | ECFMG (01) | AZ |
R77231 | ARIZONA MEDICAL BOARD (01) | AZ |