MEDICARE: MRS. GINA GASSER JORDAN FNP

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	363L00000X	Nurse Practitioner	5175017-8900	UT

General Provider Information

NPI Number	:	1346104973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GINA GASSER JORDAN FNP

Provider Business Mailing Address
First Line	:	1635 N 200 E
Second Line	:
City	:	NORTH LOGAN
State	:	UT
Zip	:	84341-1913
Country	:	US
Telephone Number	:	435-565-6043
Fax Number	:

Provider Business Practice Location Address
First Line	:	1635 N 200 E
Second Line	:
City	:	NORTH LOGAN
State	:	UT
Zip	:	84341-1913
Country	:	US
Telephone Number	:	435-565-6043
Fax Number	:

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

Provider Enumeration Date	:	12/09/2025
Last Update Date	:	12/09/2025

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