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NPI Code Detail

MEDICARE: JORDAN ANTHONY

MEDICARE: JORDAN ANTHONY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1194350009
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN ANTHONY
Provider Business Mailing Address
First Line : 8927 W HAWTHORNE AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53226-4703
Country : US
Telephone Number : 920-265-0786
Fax Number :
Provider Business Practice Location Address
First Line : 3409 N DOWNER AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53211-2934
Country : US
Telephone Number : 414-229-3914
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/11/2020
Last Update Date : 03/11/2020

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Directions to “ JORDAN ANTHONY ” Practice Location

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