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General NPI Number Information
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NPI Number | 1730848862
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Entity Type | Individual
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Provider Name | JORDYN NICOLE DORMAN
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Gender | Female
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Dates
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Enumeration Date | 12/16/2021
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Last Update Date | 12/22/2021
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Provider Practice Location Address
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Address Line | 3333 N SEMINARY ST
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City | GALESBURG
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State | IL
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Zip | 61401-1251
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Country | US
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Telephone | 309-344-6161
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Fax |
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Provider Business Mailing Address
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Address Line | 750 W OLD VINE ST
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City | CANTON
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State | IL
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Zip | 61520
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Country | US
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Telephone | 309-259-0114
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 209024585
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 041503368
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License Number State | IL
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