Jodi L Space (NPI# 1518217280, PAC ID# 3971758962) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is NURSE PRACTITIONER.
| Nation Provider ID (NPI) | 1518217280 |
| PAC ID by PECOS | 3971758962 |
| Professional Enrollment ID | I20130222000413 |
| Full Name | Jodi L Space |
| Organization Legal Name | LANGLADE HOSPITAL HOTEL DIEU OF ST JOSEPH OF ANTIGO WISCONSIN |
| Address |
W10618 Clinic St Elcho WI 54428-9619 |
| Phone Number | 7152754011 |
| Gender | F |
| Medical School | UNIVERSITY OF MISSOURI, COLUMBIA SCHOOL OF MEDICINE |
| Graduation Year | 2012 |
| Primary Specialty | NURSE PRACTITIONER |
| Group Practice PAC ID | 1557271202 |
| Number of Group Practice Members | 46 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 521350 | LANGLADE HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| W10618 Clinic St, Elcho, WI 54428-9619 | 7152754011 | LANGLADE HOSPITAL HOTEL DIEU OF ST JOSEPH OF ANTIGO WISCONSIN |
| Organization Legal Name | LANGLADE HOSPITAL HOTEL DIEU OF ST JOSEPH OF ANTIGO WISCONSIN |
| Physicians | 49 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Gina E Ramthun | Nurse Practitioner | Langlade Hospital Hotel Dieu of St Joseph of Antigo Wisconsin | 110 E 5th Ave, Antigo, WI 54409-2710 |
| Kasra A Milani | Hospitalist | Langlade Hospital Hotel Dieu of St Joseph of Antigo Wisconsin | 112 E 5th Ave, Antigo, WI 54409-2710 |
| Debra A Safford | Nurse Practitioner | Langlade Hospital Hotel Dieu of St Joseph of Antigo Wisconsin | 110 E 5th Ave, Antigo, WI 54409-2710 |
| Angela E Buchman | Physician Assistant | Langlade Hospital Hotel Dieu of St Joseph of Antigo Wisconsin | 110 E 5th Ave, Antigo, WI 54409-2710 |
| Andrea L Pennington | Physician Assistant | Langlade Hospital Hotel Dieu of St Joseph of Antigo Wisconsin | 110 E 5th Ave, Antigo, WI 54409-2710 |
| Dennis Mcfadden | Obstetrics/gynecology | Langlade Hospital Hotel Dieu of St Joseph of Antigo Wisconsin | 110 E 5th Ave, Antigo, WI 54409-2710 |
| Carlos X Condado | Certified Registered Nurse Anesthetist (crna) | Langlade Hospital Hotel Dieu of St Joseph of Antigo Wisconsin | 112 E 5th Ave, Antigo, WI 54409-2710 |
| Kara Hall | Clinical Social Worker | Langlade Hospital Hotel Dieu of St Joseph of Antigo Wisconsin | 110 E 5th Ave, Antigo, WI 54409-2710 |
| Kyle J Dembowiak | Family Medicine | Langlade Hospital Hotel Dieu of St Joseph of Antigo Wisconsin | 110 E 5th Ave, Antigo, WI 54409-2710 |
| Tanya B Lechtev | Internal Medicine | Langlade Hospital Hotel Dieu of St Joseph of Antigo Wisconsin | 112 E 5th Ave, Antigo, WI 54409-2710 |
| Street Address |
W10618 CLINIC ST |
| City | ELCHO |
| State | WI |
| Zip | 54428-9619 |
| City | ELCHO |
| Zip Code | 54428 |
| Specialty | NURSE PRACTITIONER |
| City + Specialty | ELCHO + NURSE PRACTITIONER |
Please comment or provide details below to improve the information on Jodi L Space.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.