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NPI Code Detail

MEDICARE: JORDAN REZNECHECK

MEDICARE: JORDAN REZNECHECK
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training ProgramMN

General Provider Information

NPI Number : 1073967774
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN REZNECHECK
Provider Business Mailing Address
First Line : 1831 6TH ST E
Second Line :
City : WEST FARGO
State : ND
Zip : 58078-4230
Country : US
Telephone Number : 701-212-0680
Fax Number :
Provider Business Practice Location Address
First Line : 1831 6TH ST E
Second Line :
City : WEST FARGO
State : ND
Zip : 58078-4230
Country : US
Telephone Number : 701-212-0680
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2016
Last Update Date : 04/19/2016

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Directions to “ JORDAN REZNECHECK ” Practice Location

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