Provider Demographics
NPI:1053531426
Name:WINTER, JODIE LYNN (RN)
Entity type:Individual
Prefix:MISS
First Name:JODIE
Middle Name:LYNN
Last Name:WINTER
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 1:3797 WESTERN CT
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54901-1196
Mailing Address - Country:US
Mailing Address - Phone:920-277-4864
Mailing Address - Fax:
Practice Address - Street 1:542 CAMELOT CT APT 1
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901-1880
Practice Address - Country:US
Practice Address - Phone:920-232-8118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38276300Medicaid