| Doctor Name: | MRS. JODI BANGASSER |
| NPI Number: | 1023465267 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ARNP |
| License Number: | H095679 |
| Business Practice Address: | 312 9th St Sw Waverly, IA - 506772929 |
| Business Phone Number: | 3194831365 |
| Business Fax Number: | 3193523992 |
| Mailing Address: | 338 Hickory St, ALLISON |
| State: | IA |
| Postal Code: | 506027801 |
| Phone Number: | 6414254346 |
| Fax Number: | 3192672234 |
| NPI Enumeration Date: | 05/18/2016 |
| NPI Last Update Date: | 05/18/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP2300X |
| License Number: | H095679 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |