Individual
JODI RANAE ROTHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
HIS
Contact information
Practice address
17316 KENYON AVE, SUITE 102, LAKEVILLE, MN 55044-6909
(952) 255-8579
(952) 255-8578
Mailing address
17316 KENYON AVE, SUITE 102, LAKEVILLE, MN 55044-6909
(952) 255-8579
(952) 255-8578
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
2480
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2480
MN DEPARTMENT OF HEALTH
MN
Enumeration date
03/13/2012
Last updated
03/13/2012
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