Basic Information
| Provider Information | |||||||||
| NPI: | 1073891487 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MEDEIROS | ||||||||
| FirstName: | JODIE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 387 QUARRY ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | FALL RIVER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027231025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086798111 | ||||||||
| FaxNumber: | 5086744286 | ||||||||
| Practice Location | |||||||||
| Address1: | 387 QUARRY ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | FALL RIVER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027231025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086798111 | ||||||||
| FaxNumber: | 5086744286 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2011 | ||||||||
| LastUpdateDate: | 01/04/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | LN51966 | MA | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.