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General NPI Number Information
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NPI Number | 1295546950
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Entity Type | Individual
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Provider Name | JORDAN CLEARY APRN
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Gender | Female
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Dates
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Enumeration Date | 01/14/2025
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 1404 E STATE ST
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City | ROCKFORD
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State | IL
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Zip | 61104-2335
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Country | US
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Telephone | 779-696-4400
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Fax |
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Provider Business Mailing Address
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Address Line | 4791 E 18TH RD
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City | LELAND
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State | IL
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Zip | 60531-9501
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Country | US
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Telephone | 815-830-0577
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209.031016
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License Number State | IL
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