JODI A. DETTMAN (NPI# 1720269178) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720269178 |
| Entity Type | Individual |
| Full Name | JODI A. DETTMAN |
| Credential | CNP |
| Practice Address |
104 Quail Trl Unit B Edgewood NM 87015-7185 |
| Practice Telephone | 5052080204 |
| Mailing Telephone | 5052080204 |
| Enumeration Date | 2007-11-14 |
| Last Update Date | 2018-05-04 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
CNP01152 | NM | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
104 QUAIL TRL UNIT B |
| City | EDGEWOOD |
| State | NM |
| Zip Code | 87015-7185 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083112437 | East Mountain Medical, LLC | Family Medicine | 104 Quail Trl Unit B, Edgewood, NM 87015 | 2018-01-30 |
| 1902333776 | Placitas Mountain Medical, Inc | Clinic/Center | 104 Quail Trl Unit B, Edgewood, NM 87015-7185 | 2017-05-11 |
| 1497280143 | Sandia Mountain Medical, Inc. | Clinic/Center | 104 Quail Trl Unit B, Edgewood, NM 87015-7185 | 2017-05-01 |
| 1407294655 | John Edward Panter | Physician Assistant | 104 Quail Trl Unit B, Edgewood, NM 87015-7185 | 2013-06-10 |
| 1669796595 | Effie E Medford | Specialist | 104 Quail Trl Unit B, Edgewood, NM 87015-7185 | 2010-03-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740772490 | Laura Hunsucker | Physical Therapist | 1090 Mountain Valley Road, Edgewood, NM 87015 | 2018-05-30 |
| 1295194629 | Ryan Grange | Physician Assistant | 1851 Old Highway 66 Unit 1, Edgewood, NM 87015 | 2016-02-12 |
| 1376895250 | Bianca Genco-morrison | Social Worker | 17 Venus Rd. West, Edgewood, NM 87015 | 2012-10-03 |
| 1447541909 | Rona H Vanwilligen | Physical Therapist | 1851 Highway 333, 2-b, Edgewood, NM 87015 | 2011-05-02 |
| 1679717789 | Alan Mannheimer | Pediatrics | 104 Quail Trail, Unit B, Edgewood, NM 87015 | 2009-04-21 |
| 1003085705 | Wal-mart Stores East, Lp | Eyewear Supplier (Equipment, not the service) | 66 State Road #344, Edgewood, NM 87015 | 2008-02-27 |
| 1821270828 | Fowler Enterprises, Inc. | Physical Therapist | 1851-2b Old Highway 66, Edgewood, NM 87015 | 2007-11-30 |
| 1366630121 | Jeana Spindle | Speech-Language Pathologist | 27 Camino Estribor, Edgewood, NM 87015 | 2007-10-05 |
| 1679794457 | Sharon Louise Meyer | Social Worker | 14 El Prado, Edgewood, NM 87015 | 2007-05-01 |
| 1912035478 | Cecilia Gonzales Morris | Occupational Therapist | 204 Dinkle Road, Edgewood, NM 87015 | 2007-02-28 |
| Find all providers in zip 87015 | ||||
| Taxonomy Code | 363LA2200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Adult Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043778160 | A Platform To Healthcare | Nurse Practitioner | 325 Ahern Dr, Edgewood, MD 21040-3410 | 2019-03-07 |
| 1679041404 | Cara Ann Lundin | Nurse Practitioner | 11926 43rd St Crt E, Edgewood, WA 98372 | 2018-11-09 |
| 1215284674 | Dayon Rochelle Nelson | Nurse Practitioner | 1952 Pulaski Hwy, Edgewood, MD 21040-1617 | 2012-08-04 |
| 1285921106 | Autumn L. Schneider | Nurse Practitioner | 830 Thomas More Parkway, Ste 202, Edgewood, KY 41017 | 2011-06-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619323284 | Amy Elise Lopez | Nurse Practitioner | 4402 Superstition Dr, Las Cruces, NM 88011 | 2016-05-12 |
| 1841662095 | Barbara Lynn Edmunds-kimrey | Nurse Practitioner | 8801 Horizon Blvd., Suite 260, United Health Care- Optum, Albuquerque, NM 87109 | 2015-10-28 |
| 1518341759 | Karen Elizabeth Kirst-millspaugh | Nurse Practitioner | 209 E. Allen Ayers Rd., Estancia, NM 87016 | 2015-07-17 |
| 1336542992 | Fusion Health & Wellness | Nurse Practitioner | 2402 W Pierce St Ste 6g, Ste 6g, Carlsbad, NM 88220-3566 | 2014-09-26 |
| 1609129691 | Wayne Bryan Chowaniec | Nurse Practitioner | Unm Cancer Center Msc07 4025 1201 Camino De, 1 University of New Mexico, Albuquerque, NM 87131-0001 | 2012-10-16 |
| 1972853349 | Carla Rae Kychik | Nurse Practitioner | 163 Brannon, Tijeras, NM 87059 | 2012-09-13 |
| 1912208323 | Lisa Marie Meyer | Nurse Practitioner | 2539 Medical Drive, Suite 107, Gerald Champion Regional Medical Center, Alamogordo, NM 88310 | 2010-11-16 |
| 1568777530 | Jacqueline Del Val | Nurse Practitioner | 622 W Maple St Ste F, Farmington, NM 87401-6589 | 2010-08-13 |
| 1548439060 | Lynn Engler | Nurse Practitioner | Msc10 5550 1 University of New Mexico, Albuquerque, NM 87131-0001 | 2008-02-28 |
| 1992911432 | Lorraine Ann Goss | Nurse Practitioner | 5 Camino Del Sol St., Corales, NM 87048 | 2007-05-14 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.