Jodi Ann Buckett Vanwormer
Individual provider Active NPI Adult Care Home Facility · Elkhorn, WI
NPI 1780411983 · NPPES record last updated Sep 19, 2024
Key facts
- NPI
- 1780411983
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Adult Care Home Facility 311ZA0620X
- License
- 0010620 (WI)
- Practice address
- W3928 Potter Rd
Elkhorn, WI 53121-4041 - Phone
- (262) 723-1936
- NPI assigned
- Sep 19, 2024
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0010620 | WI | MD | Adult Care Home Facility |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Care Home Facility | 311ZA0620X | 0010620 | WI | Yes |
Addresses
Primary practice location
W3928 Potter Rd
Elkhorn, WI 53121-4041
Mailing address
W3928 Potter Rd
Elkhorn, WI 53121-4041
Phone (262) 723-1936
Other providers in Elkhorn, WI
- Cheryl Brost
- Mark F Brower
- Ryan Brower
- Mary L Brown
- Barbara J Buchheit
- Kristin Budde
- Robert Edward Bulin
- Traci L Bulow
- Megan Burg
- Lindsey Jo Provenzano Burgess
All providers in Elkhorn, WI · Adult Care Home Facility in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 19, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.