Individual
JORDAN ANN WIEDMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4040 42ND ST S STE N, FARGO, ND 58104-4352
(701) 543-5533
Mailing address
2822 2ND ST N, FARGO, ND 58102-1606
(701) 543-5533
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1174572
ND
Other
Enumeration date
06/29/2020
Last updated
12/04/2024
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