Individual
JORDAN IVERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2301 25TH ST S, FARGO, ND 58103-6104
(701) 361-1320
Mailing address
29791 80TH AVE N, HITTERDAL, MN 56552-9794
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Enumeration date
02/11/2018
Last updated
02/11/2018
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