Healthcare Provider Details

I. General information

NPI: 1396082236
Provider Name (Legal Business Name): JODI K. WEICHMANN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2013
Last Update Date: 01/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 E PARK AVE
MONTICELLO WI
53570-9675
US

IV. Provider business mailing address

512 E PARK AVE
MONTICELLO WI
53570-9675
US

V. Phone/Fax

Practice location:
  • Phone: 608-279-9854
  • Fax:
Mailing address:
  • Phone: 608-279-9854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number193538-30
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number193538-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: