Provider Demographics
NPI:1063091239
Name:LOESCH, JODIE ANNE (RN)
Entity type:Individual
Prefix:
First Name:JODIE
Middle Name:ANNE
Last Name:LOESCH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JODIE
Other - Middle Name:ANNE
Other - Last Name:DUBOIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:9615 W AKRON RD
Mailing Address - Street 2:
Mailing Address - City:PRINCEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61559-9514
Mailing Address - Country:US
Mailing Address - Phone:309-657-6361
Mailing Address - Fax:
Practice Address - Street 1:9615 W AKRON RD
Practice Address - Street 2:
Practice Address - City:PRINCEVILLE
Practice Address - State:IL
Practice Address - Zip Code:61559-9514
Practice Address - Country:US
Practice Address - Phone:309-657-6361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-05
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041185375163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse