Individual
NICOLE MARIE JODAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
601 N BARKER RD STE 110, BROOKFIELD, WI 53045-5929
(262) 785-0777
(262) 785-8029
Mailing address
601 N BARKER RD STE 110, BROOKFIELD, WI 53045-5929
(262) 785-0777
(262) 785-8029
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
2335-023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1871742627
—
WI
Enumeration date
09/17/2008
Last updated
04/03/2020
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