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General NPI Number Information
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NPI Number | 1033549381
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Entity Type | Individual
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Provider Name | JODIE EICKHOFF N.P.-BC
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Gender | Female
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Dates
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Enumeration Date | 11/24/2013
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Last Update Date | 08/02/2016
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Provider Practice Location Address
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Address Line | 6535 ROCHESTER RD STE 2
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City | TROY
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State | MI
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Zip | 48085-1362
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Country | US
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Telephone | 248-813-0060
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Fax |
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Provider Business Mailing Address
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Address Line | 6535 ROCHESTER RD STE 102
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City | TROY
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State | MI
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Zip | 48085-1362
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Country | US
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Telephone | 810-241-4833
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 4704240718
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License Number State | MI
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