Healthcare Provider Details

I. General information

NPI: 1053936807
Provider Name (Legal Business Name): JORDAN WARGEL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2020
Last Update Date: 08/08/2022
Certification Date: 08/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 US HIGHWAY 45 N
ELDORADO IL
62930-3770
US

IV. Provider business mailing address

PO BOX 155
CHRISTOPHER IL
62822-0155
US

V. Phone/Fax

Practice location:
  • Phone: 618-273-2951
  • Fax: 618-273-2726
Mailing address:
  • Phone: 618-724-2401
  • Fax: 618-724-4628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209021436
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: