Provider Demographics
NPI:1174692032
Name:LOHSE, JODY KATHARINA
Entity type:Individual
Prefix:
First Name:JODY
Middle Name:KATHARINA
Last Name:LOHSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 FRONT STREET
Mailing Address - Street 2:P.O.BOX 92
Mailing Address - City:HENNING
Mailing Address - State:MN
Mailing Address - Zip Code:56551
Mailing Address - Country:US
Mailing Address - Phone:218-583-4428
Mailing Address - Fax:218-583-2504
Practice Address - Street 1:609 FRONT STREET
Practice Address - Street 2:
Practice Address - City:HENNING
Practice Address - State:MN
Practice Address - Zip Code:56551
Practice Address - Country:US
Practice Address - Phone:218-583-4428
Practice Address - Fax:218-583-2504
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility