Healthcare Provider Details

I. General information

NPI: 1013622331
Provider Name (Legal Business Name): JORDAN DONGES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JORDAN YOUNG

II. Dates (important events)

Enumeration Date: 01/20/2023
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 S UNION AVE UNIT 100
ALLIANCE OH
44601-4355
US

IV. Provider business mailing address

1900 S UNION AVE UNIT 100
ALLIANCE OH
44601-4355
US

V. Phone/Fax

Practice location:
  • Phone: 330-596-6500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.008318RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: