Individual
TERESA LYNNE JODWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
209 FLORENCE AVE, GRANGER, IN 46530-8048
(574) 246-1000
(574) 246-4000
Mailing address
11983 JEFFERSON BLVD, MISHAWAKA, IN 46545-7817
(574) 259-6836
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
71000447A
IN
363LP0200X
Pediatric Nurse Practitioner
Primary
71000447A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200204520
—
IN
01
—
28103938A
RN LICENSE
IN
01
—
71000447A
NP LICENSE
IN
Enumeration date
11/17/2006
Last updated
04/08/2015
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