Provider Demographics
NPI:1215146550
Name:WINTERS, JODI LYNN (PAC)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:LYNN
Last Name:WINTERS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:LYNN
Other - Last Name:BADALI-WINTERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1601 SAINT FRANCIS AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-3383
Mailing Address - Country:US
Mailing Address - Phone:952-428-3535
Mailing Address - Fax:
Practice Address - Street 1:1515 SAINT FRANCIS AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-3387
Practice Address - Country:US
Practice Address - Phone:952-403-3535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant