Provider Demographics
NPI:1194918342
Name:BRUNDIGE, JODI ANNE (LPN)
Entity type:Individual
Prefix:MS
First Name:JODI
Middle Name:ANNE
Last Name:BRUNDIGE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:ANNE
Other - Last Name:SCHULTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:7 JOHN ST APT 1
Mailing Address - Street 2:
Mailing Address - City:HOOSICK FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12090-1633
Mailing Address - Country:US
Mailing Address - Phone:838-839-1344
Mailing Address - Fax:
Practice Address - Street 1:84 QUAKER RD
Practice Address - Street 2:
Practice Address - City:JOHNSONVILLE
Practice Address - State:NY
Practice Address - Zip Code:12094-3022
Practice Address - Country:US
Practice Address - Phone:518-705-9811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY267328164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse