Provider Demographics
NPI:1124480041
Name:MURPHY, JODELLE (CNS)
Entity type:Individual
Prefix:
First Name:JODELLE
Middle Name:
Last Name:MURPHY
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:JODELLE
Other - Middle Name:
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3092 RIVER FALLS CT NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-5643
Mailing Address - Country:US
Mailing Address - Phone:712-790-8335
Mailing Address - Fax:
Practice Address - Street 1:1216 2ND ST SW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55902
Practice Address - Country:US
Practice Address - Phone:507-255-5533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR196604-6163W00000X
MN506364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse