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General NPI Number Information
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NPI Number | 1073303277
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Entity Type | Individual
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Provider Name | JORDAN HARLOW NP
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Gender | Male
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Dates
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Enumeration Date | 05/09/2025
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Last Update Date | 09/05/2025
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Provider Practice Location Address
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Address Line | 213 N MAIN ST
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City | MOSCOW
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State | ID
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Zip | 83843-2700
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Country | US
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Telephone | 208-882-7565
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3687
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City | COEUR D ALENE
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State | ID
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Zip | 83816-2529
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Country | US
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Telephone | 208-819-2183
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Fax | 208-209-6063
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 2171158
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License Number State | ID
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