Healthcare Provider Details

I. General information

NPI: 1629170618
Provider Name (Legal Business Name): JODY L JONDRO CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JODY L SHOWALTER CRNA

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 12/07/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 N 12TH ST
MOUNT VERNON IL
62864-2857
US

IV. Provider business mailing address

202 PROSPECT DR
GLENDIVE MT
59330-1999
US

V. Phone/Fax

Practice location:
  • Phone: 618-241-1108
  • Fax: 618-241-3805
Mailing address:
  • Phone: 406-345-3306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR54232
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209004625
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number196115
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: