Individual
JORDAN N KNICKERBOCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3150 N 12TH ST, GRAND JUNCTION, CO 81506-2863
(970) 254-2642
Mailing address
PO BOX 10700, GRAND JUNCTION, CO 81502-5517
(970) 254-2642
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
PENDING
CO
Other
Enumeration date
07/17/2023
Last updated
10/16/2024
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