MEDICARE: MRS. JODI MARIE JORDAN PA-C

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
1	363AM0700X	Medical Physician Assistant	MA003598L	PA
2	363A00000X	Physician Assistant	MA003598L	PA

General Provider Information

NPI Number	:	1245262815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JODI MARIE JORDAN PA-C

Provider Business Mailing Address
First Line	:	100 N ACADEMY AVE
Second Line	:
City	:	DANVILLE
State	:	PA
Zip	:	17822-4903
Country	:	US
Telephone Number	:	570-271-6144
Fax Number	:	570-271-6578

Provider Business Practice Location Address
First Line	:	14229 ROUTE 35
Second Line	:
City	:	RICHFIELD
State	:	PA
Zip	:	17086-8711
Country	:	US
Telephone Number	:	717-694-9909
Fax Number	:	717-694-9912

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	07/30/2020

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