Healthcare Provider Details

I. General information

NPI: 1225761430
Provider Name (Legal Business Name): JORDAN LUNDY SLAUGHTER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2022
Last Update Date: 09/19/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65371 WA-14
WHITE SALMON WA
98672-1074
US

IV. Provider business mailing address

PO BOX 1074
WHITE SALMON WA
98672-1074
US

V. Phone/Fax

Practice location:
  • Phone: 509-493-2133
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: