Individual
JODY JOSEPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
2349 LAKE AVE STE 100, PLYMOUTH, IN 46563-7836
(574) 472-6700
(574) 941-3112
Mailing address
PO BOX 6309, SOUTH BEND, IN 46660-6309
(574) 472-6700
(574) 335-0760
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71002470A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000562397
ANTHEM, BCBS
IN
01
—
000000726441
BCBS
IN
01
—
000000726441
BCBS
—
05
—
200893890
—
IN
Enumeration date
03/20/2008
Last updated
08/27/2013
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