Provider Demographics
NPI:1902586837
Name:COLLIEN, JODI (RN)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:COLLIEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:
Other - Last Name:KELMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1025 ETON CT
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53029-2710
Mailing Address - Country:US
Mailing Address - Phone:920-979-0096
Mailing Address - Fax:
Practice Address - Street 1:1025 ETON CT
Practice Address - Street 2:
Practice Address - City:HARTLAND
Practice Address - State:WI
Practice Address - Zip Code:53029-2710
Practice Address - Country:US
Practice Address - Phone:920-979-0096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI201499-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse