Provider Demographics
NPI:1124776992
Name:SMITH, JODI MICHELE (RN)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:MICHELE
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:MICHELE
Other - Last Name:KESTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:746 COUNTY ROUTE 25
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-5712
Mailing Address - Country:US
Mailing Address - Phone:315-532-8098
Mailing Address - Fax:
Practice Address - Street 1:255 E 12TH ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-2807
Practice Address - Country:US
Practice Address - Phone:315-532-8098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-11
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY733845163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics