Healthcare Provider Details

I. General information

NPI: 1346209392
Provider Name (Legal Business Name): JENNIFER ANN CODDINGTON DNP, MSN, RN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 08/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 N UNIVERSITY ST JOHNSON HALL RM B-5
WEST LAFAYETTE IN
47907-2069
US

IV. Provider business mailing address

502 N UNIVERSITY ST JOHNSON HALL RM B-5
WEST LAFAYETTE IN
47907-2069
US

V. Phone/Fax

Practice location:
  • Phone: 765-494-6341
  • Fax: 765-496-1022
Mailing address:
  • Phone: 765-494-6341
  • Fax: 765-496-1022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number71000722A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: