Provider Demographics
NPI:1679687511
Name:CARTER, JODI ANN
Entity type:Individual
Prefix:MRS
First Name:JODI
Middle Name:ANN
Last Name:CARTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22434 ZEP RD E
Mailing Address - Street 2:
Mailing Address - City:SARAHSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43779-9702
Mailing Address - Country:US
Mailing Address - Phone:740-732-7197
Mailing Address - Fax:740-732-0107
Practice Address - Street 1:22434 ZEP RD E
Practice Address - Street 2:
Practice Address - City:SARAHSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43779-9702
Practice Address - Country:US
Practice Address - Phone:740-732-7197
Practice Address - Fax:740-732-0107
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN061572164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse