Provider Demographics
NPI:1306128251
Name:CUSACK, JODI B (PA-C)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:B
Last Name:CUSACK
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:1150 RESERVOIR AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-6043
Mailing Address - Country:US
Mailing Address - Phone:401-943-1300
Mailing Address - Fax:401-228-7109
Practice Address - Street 1:1150 RESERVOIR AVE STE 201
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920
Practice Address - Country:US
Practice Address - Phone:401-943-1300
Practice Address - Fax:401-228-7109
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2018-06-29
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant