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General NPI Number Information
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NPI Number | 1396223962
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Entity Type | Individual
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Provider Name | JORDAN EMILY YSETH RDN
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Gender | Female
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Dates
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Enumeration Date | 08/05/2018
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Last Update Date | 08/05/2018
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Provider Practice Location Address
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Address Line | 2230 COMO AVE.
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City | ST. PAUL
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State | MN
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Zip | 55108
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Country | US
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Telephone | 651-645-5323
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Fax |
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Provider Business Mailing Address
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Address Line | 1516 ASHLAND AVE APT D
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City | SAINT PAUL
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State | MN
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Zip | 55104-6712
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Country | US
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Telephone | 763-486-0271
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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