Provider Demographics
NPI:1063307080
Name:JODI OLDFATHER, CRNA LLC
Entity type:Organization
Organization Name:JODI OLDFATHER, CRNA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JODI
Authorized Official - Middle Name:
Authorized Official - Last Name:OLDFATHER
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:808-282-5317
Mailing Address - Street 1:99 PILIALOHA ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-1865
Mailing Address - Country:US
Mailing Address - Phone:808-282-5317
Mailing Address - Fax:
Practice Address - Street 1:82 PUUHONU PL STE 100
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2010
Practice Address - Country:US
Practice Address - Phone:808-969-9669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical