Provider Demographics
NPI:1972723518
Name:DE JONGE, JODY E (RN)
Entity type:Individual
Prefix:
First Name:JODY
Middle Name:E
Last Name:DE JONGE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4190 SUMMERMEADOW DR
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-5894
Mailing Address - Country:US
Mailing Address - Phone:801-296-9744
Mailing Address - Fax:
Practice Address - Street 1:4190 SUMMERMEADOW DR
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-5894
Practice Address - Country:US
Practice Address - Phone:801-296-9744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2769613102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse