Healthcare Provider Details

I. General information

NPI: 1700876059
Provider Name (Legal Business Name): JEANNE I RODMAN NPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 01/03/2023
Certification Date: 01/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 N COMMERCIAL ST
SEYMOUR MO
65746-8858
US

IV. Provider business mailing address

PO BOX 802843
KANSAS CITY MO
64180-2843
US

V. Phone/Fax

Practice location:
  • Phone: 417-269-2100
  • Fax: 417-269-2103
Mailing address:
  • Phone: 417-730-6430
  • Fax: 417-269-7567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number136622
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: