Healthcare Provider Details

I. General information

NPI: 1235717729
Provider Name (Legal Business Name): JORDAN KATHLEEN HUTTASH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HAWKINS DR
IOWA CITY IA
52242-1009
US

IV. Provider business mailing address

747 BROADWAY HEATH BUILDING, 10TH FLOOR
SEATTLE WA
98122-4307
US

V. Phone/Fax

Practice location:
  • Phone: 319-384-6511
  • Fax:
Mailing address:
  • Phone: 206-386-2123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberML61165285
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number1071169
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberR-12474
License Number StateIA
# 4
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD224250
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: