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General NPI Number Information
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NPI Number | 1457174112
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Entity Type | Individual
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Provider Name | JORDAN J EUBANKS BSN, RN
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Gender | Female
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Dates
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Enumeration Date | 11/01/2024
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Last Update Date | 11/01/2024
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Provider Practice Location Address
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Address Line | 777 AVENUE H
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City | POWELL
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State | WY
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Zip | 82435-2260
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Country | US
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Telephone | 307-754-2267
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Fax |
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Provider Business Mailing Address
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Address Line | 6 SCHNEIDER RD
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City | CODY
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State | WY
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Zip | 82414-9232
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Country | US
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Telephone | 307-250-4825
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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 | 163WE0003X
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Taxonomy Name | Emergency Registered Nurse
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License Number | 41599
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License Number State | WY
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