Healthcare Provider Details

I. General information

NPI: 1417610601
Provider Name (Legal Business Name): JORDAN ANN MONDT DNP, APRN, CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2021
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 SMITH AVE N STE 480
SAINT PAUL MN
55102-2377
US

IV. Provider business mailing address

9475 LAKE RD
WOODBURY MN
55125-9034
US

V. Phone/Fax

Practice location:
  • Phone: 314-577-5609
  • Fax:
Mailing address:
  • Phone: 314-650-0230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number2021041457
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: