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Individual

JORDAN IDSO

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CRNA

Contact information

Practice address
801 BROADWAY N, FARGO, ND 58102-3641
(701) 234-2868
Mailing address
PO BOX 5074, SIOUX FALLS, SD 57117-5074

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R36530
ND

Other

Enumeration date
01/27/2017
Last updated
05/19/2022
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