Individual
JORDAN MCLAINE ICENOGGLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1200 WESTWOOD DR STE G, HAMILTON, MT 59840-2345
(406) 375-4777
(406) 375-4778
Mailing address
1224 W MAIN ST, HAMILTON, MT 59840-2338
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
MED-PHYS-LIC-148113
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200034207
—
MT
Enumeration date
03/30/2021
Last updated
10/03/2025
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