Individual
JORDAN FAVIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1400 ENERGY PARK DR, SAINT PAUL, MN 55108-5272
(651) 252-6070
Mailing address
1400 ENERGY PARK DR, SAINT PAUL, MN 55108-5272
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
304003
LICENSE
—
Enumeration date
04/20/2016
Last updated
04/20/2016
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