Provider Demographics
NPI:1043000102
Name:WISEMAN, JODI FREDONIA (CNA TRAINING)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:FREDONIA
Last Name:WISEMAN
Suffix:
Gender:F
Credentials:CNA TRAINING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 2 BOX 715
Mailing Address - Street 2:
Mailing Address - City:BAYARD
Mailing Address - State:NE
Mailing Address - Zip Code:69334-2500
Mailing Address - Country:US
Mailing Address - Phone:308-641-0883
Mailing Address - Fax:
Practice Address - Street 1:590 7TH ST APT 2
Practice Address - Street 2:
Practice Address - City:GERING
Practice Address - State:NE
Practice Address - Zip Code:69341-3550
Practice Address - Country:US
Practice Address - Phone:308-641-0883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-10
Last Update Date:2025-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE372500000X, 372600000X
372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty
No372500000XNursing Service Related ProvidersChore Provider