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General NPI Number Information
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NPI Number | 1851381354
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Entity Type | Individual
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Provider Name | JENNIFER J NORDSTROM MD
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Gender | Female
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Dates
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Enumeration Date | 10/26/2005
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Last Update Date | 09/15/2020
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Provider Practice Location Address
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Address Line | 1303 S MAIN ST
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City | HOLMEN
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State | WI
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Zip | 54636
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Country | US
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Telephone | 608-785-0940
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1510
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City | EAU CLAIRE
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State | WI
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Zip | 54702-1510
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Country | US
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Telephone | 608-785-0940
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 47663
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 45993
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License Number State | WI
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