Individual
JENNA JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
16555 MANCHESTER RD, SUITE 100, WILDWOOD, MO 63040-1220
(636) 458-0646
Mailing address
16555 MANCHESTER RD, SUITE 100, WILDWOOD, MO 63040-1220
(636) 458-0646
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
2015010970
MO
363LA2200X
Adult Health Nurse Practitioner
Primary
2015032917
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1932572393
—
MO
Enumeration date
11/07/2015
Last updated
05/26/2016
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