Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | H095679 | IA |
NPI | 1023465267 |
---|---|
Provider Name | Mrs. Jodi Bangasser |
First Address | Allison, IA 50602-7801 |
Second Address | Waverly, IA 50677-2929 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2016 |
Last Update Date | 18/05/2016 |