Individual
MRS. JODI L SPACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APNP
Contact information
Practice address
5416 EVERYBODYS RD, CRANDON, WI 54520-8627
(715) 478-4890
Mailing address
5416 EVERYBODYS RD, CRANDON, WI 54520-8627
(715) 478-4890
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
5012
WI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
5012-33
WI
Other
Enumeration date
09/10/2012
Last updated
01/19/2022
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