Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | R0053999 | OK |
NPI | 1003986563 |
---|---|
Provider Name | Jodi M Dodson |
First Address | Edmond, OK 73003-4142 |
Second Address | Norman, OK 73072-4103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2006 |
Last Update Date | 13/05/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200100030A | (05) | OK |