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General NPI Number Information
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NPI Number | 1225181647
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Entity Type | Individual
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Provider Name | JANA M. JORDAN ATC
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Gender | Female
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 101 14TH ST NE SUITE A
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City | BUFFALO
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State | MN
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Zip | 55313-2927
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Country | US
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Telephone | 763-684-3899
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Fax | 763-684-3881
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Provider Business Mailing Address
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Address Line | 712 SUNSET ST
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City | BUFFALO
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State | MN
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Zip | 55313-3745
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Country | US
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Telephone | 763-682-2376
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Fax |
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 1667
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License Number State | MN
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