Healthcare Provider Details

I. General information

NPI: 1871168112
Provider Name (Legal Business Name): JORDAN CALL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2021
Last Update Date: 06/25/2021
Certification Date: 06/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5880 N HOSPITAL DR
GLOBE AZ
85501
US

IV. Provider business mailing address

1908 W HEATHER RD
MAPLETON UT
84664-4617
US

V. Phone/Fax

Practice location:
  • Phone: 928-425-3261
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number259682
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: