Individual
JORDAN MCKENZIE VANDENBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
580 N CAMINO MERCADO, CASA GRANDE, AZ 85122-5757
(520) 876-0416
(520) 421-3474
Mailing address
PO BOX 749495, ATLANTA, GA 30374-9495
(239) 432-8331
(813) 321-1296
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
7283
AZ
Other
Enumeration date
09/10/2018
Last updated
06/01/2023
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