Healthcare Provider Details

I. General information

NPI: 1841495439
Provider Name (Legal Business Name): JORDAN ANNE STABINSKI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 05/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 HARVARD ST UNIT #6
BROOKLINE MA
02446
US

IV. Provider business mailing address

PO BOX 840848
DALLAS TX
75284-0848
US

V. Phone/Fax

Practice location:
  • Phone: 317-213-4840
  • Fax:
Mailing address:
  • Phone: 972-715-5000
  • Fax: 972-715-9976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number11013306
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number28948
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: