Healthcare Provider Details

I. General information

NPI: 1942098322
Provider Name (Legal Business Name): JORDAN ANDREW WARD FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 W PIONEER RD
FOND DU LAC WI
54935-6151
US

IV. Provider business mailing address

61 W PIONEER RD
FOND DU LAC WI
54935-6151
US

V. Phone/Fax

Practice location:
  • Phone: 800-464-3649
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0038972
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18009-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: