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Individual

JORDAN E TAYLOR

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PNP

Contact information

Practice address
1090 W PARK PL, COEUR D ALENE, ID 83814-2785
(208) 215-2005
Mailing address
PO BOX 1387, HAYDEN, ID 83835-1387

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP60904961
WA
363LP0200X
Pediatric Nurse Practitioner
NP729A
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000010153954
REGENCE BLUE SHIELD
ID
01
000010153955
REGENCE BLUE SHIELD
ID
05
1047507
WA
05
1144306549
MT
05
807343600
ID
05
9653353
WA
01
AP60904961
ARNP
WA
05
NP708ID
AK
01
NPXN2
BLUE CROSS OF IDAHO
ID
01
NPXN3
BLUE CROSS
ID
Enumeration date
10/27/2006
Last updated
03/04/2025
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