MEDICARE: CATHERINE MARIE JORDAN RN

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
1	163WP2201X	Ambulatory Care Registered Nurse	113002	MO

General Provider Information

NPI Number	:	1235390485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE MARIE JORDAN RN

Provider Business Mailing Address
First Line	:	PO BOX J
Second Line	:
City	:	FORT YATES
State	:	ND
Zip	:	58538-0527
Country	:	US
Telephone Number	:	701-854-3831
Fax Number	:	701-854-3685

Provider Business Practice Location Address
First Line	:	N10 NORTH RIVER ROAD
Second Line	:
City	:	FORT YATES
State	:	ND
Zip	:	58538-0527
Country	:	US
Telephone Number	:	701-854-3831
Fax Number	:	701-854-3685

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2008
Last Update Date	:	06/20/2008

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