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NPI Code Detail

MEDICARE: JODI CORINNE DELAGRAVE APNP, DNP

MEDICARE: JODI CORINNE DELAGRAVE APNP, DNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner1271WI
2363LF0000XFamily Nurse Practitioner4470MN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2528513OTHERWIUGS MEDICARE
3528514OTHERWIUGS MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
161106OTHERWIDEAN HEALTH SYSTEMS
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1811998545
Entity Type Code : Individual
Provider Name (Legal Business Name) : JODI CORINNE DELAGRAVE APNP, DNP
Provider Business Mailing Address
First Line : 540 LEONA AVE
Second Line :
City : RICHLAND CENTER
State : WI
Zip : 53581-3014
Country : US
Telephone Number : 608-475-7146
Fax Number :
Provider Business Practice Location Address
First Line : 1130 W SUNSET DR
Second Line :
City : WAUKESHA
State : WI
Zip : 53189-8422
Country : US
Telephone Number : 800-389-2727
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2005
Last Update Date : 01/12/2021

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