Individual
JORDAN VIGNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1 EDIZ HOOK, PORT ANGELES, WA 98362-2201
(360) 417-5984
Mailing address
1 EDIZ HOOK, PORT ANGELES, WA 98362-2201
(360) 417-5984
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1362300750
USCG
—
Enumeration date
09/23/2021
Last updated
09/23/2021
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