Individual
JOSE ANGEL RODRIGUEZ JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NURSE PRACTITIONER
Contact information
Practice address
60257 BODNAR BLVD, MISHAWAKA, IN 46544-9342
(574) 212-2801
Mailing address
60257 BODNAR BLVD, MISHAWAKA, IN 46544-9342
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71007457A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
28192740A
STATE OF INDIANA
IN
01
—
71007457A
STATE OF INDIANA
IN
Enumeration date
09/19/2017
Last updated
10/24/2022
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