Provider Demographics
NPI:1215333471
Name:HARTWIG, JODI (APRN, A-CNS, BC)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:HARTWIG
Suffix:
Gender:F
Credentials:APRN, A-CNS, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 ASHLAND AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-2059
Mailing Address - Country:US
Mailing Address - Phone:763-516-6688
Mailing Address - Fax:
Practice Address - Street 1:528 ASHLAND AVE APT 3
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2059
Practice Address - Country:US
Practice Address - Phone:763-516-6688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-14
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 107522-5364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health