Provider Demographics
NPI:1063743565
Name:STRAUCH, JODI L (FNP)
Entity type:Individual
Prefix:MRS
First Name:JODI
Middle Name:L
Last Name:STRAUCH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 S MARATHON AVE
Mailing Address - Street 2:
Mailing Address - City:ROBINSON
Mailing Address - State:IL
Mailing Address - Zip Code:62454-3400
Mailing Address - Country:US
Mailing Address - Phone:618-544-2121
Mailing Address - Fax:618-544-7565
Practice Address - Street 1:400 S MARATHON AVE
Practice Address - Street 2:
Practice Address - City:ROBINSON
Practice Address - State:IL
Practice Address - Zip Code:62454-3400
Practice Address - Country:US
Practice Address - Phone:618-544-2121
Practice Address - Fax:618-544-7565
Is Sole Proprietor?:No
Enumeration Date:2010-01-22
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.007528363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily