Healthcare Provider Details

I. General information

NPI: 1902471634
Provider Name (Legal Business Name): JOURDON QUINN JAYE WICHMAN APRN-CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2021
Last Update Date: 09/21/2024
Certification Date: 09/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 81
WINIFRED MT
59489-0081
US

IV. Provider business mailing address

PO BOX 81
WINIFRED MT
59489-0081
US

V. Phone/Fax

Practice location:
  • Phone: 406-390-1276
  • Fax: 800-853-6531
Mailing address:
  • Phone: 406-390-1276
  • Fax: 800-853-6531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberNUR-APRN-LIC-176408
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License NumberNUR-RN-LIC-70073
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: