Provider Demographics
NPI:1336241009
Name:PATRICK, JODIE RENEE (LPN)
Entity type:Individual
Prefix:MS
First Name:JODIE
Middle Name:RENEE
Last Name:PATRICK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 PERRY ST
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-3024
Mailing Address - Country:US
Mailing Address - Phone:812-881-5060
Mailing Address - Fax:
Practice Address - Street 1:1041 N 7TH ST
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-2268
Practice Address - Country:US
Practice Address - Phone:812-882-6069
Practice Address - Fax:812-886-5307
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27039817A164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse