Provider Demographics
NPI:1063768232
Name:ROHDE, JONATHAN E (NP)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:E
Last Name:ROHDE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 W LAKE ST
Mailing Address - Street 2:
Mailing Address - City:CHISHOLM
Mailing Address - State:MN
Mailing Address - Zip Code:55719-1817
Mailing Address - Country:US
Mailing Address - Phone:970-402-5889
Mailing Address - Fax:844-921-1071
Practice Address - Street 1:12 W LAKE ST
Practice Address - Street 2:
Practice Address - City:CHISHOLM
Practice Address - State:MN
Practice Address - Zip Code:55719-1817
Practice Address - Country:US
Practice Address - Phone:970-402-5889
Practice Address - Fax:844-921-1071
Is Sole Proprietor?:No
Enumeration Date:2012-07-25
Last Update Date:2025-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2065234363L00000X
SC19675363LF0000X
MN1541363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP3354Medicaid
MN500007718Medicare PIN
SCNP3354Medicaid