Healthcare Provider Details

I. General information

NPI: 1689088825
Provider Name (Legal Business Name): ANNE JORDAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNE CATALANO MD

II. Dates (important events)

Enumeration Date: 06/16/2014
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 W CALUMET ST
APPLETON WI
54915-4934
US

IV. Provider business mailing address

145 W CALUMET ST
APPLETON WI
54915-4934
US

V. Phone/Fax

Practice location:
  • Phone: 920-967-4141
  • Fax:
Mailing address:
  • Phone: 920-967-4141
  • Fax: 833-972-1585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301105639
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number71104-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: