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General NPI Number Information
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NPI Number | 1609103977
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Entity Type | Individual
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Provider Name | JODI L JUNG CNP
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Gender | Female
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Dates
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Enumeration Date | 11/06/2009
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 3405 6TH ST STE 5
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City | BROOKINGS
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State | SD
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Zip | 57006-4401
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Country | US
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Telephone | 605-693-7862
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Fax | 605-693-7900
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Provider Business Mailing Address
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Address Line | 3405 6TH ST STE 5
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City | BROOKINGS
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State | SD
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Zip | 57006-4401
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Country | US
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Telephone | 605-693-7862
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Fax | 605-693-7900
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | CP000580
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License Number State | SD
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | CP000580
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License Number State | SD
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