MEDICARE: JORDAN WENTWORTH

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	163W00000X	Registered Nurse	1-186169	AL

General Provider Information

NPI Number	:	1861268237
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN WENTWORTH

Provider Business Mailing Address
First Line	:	1936 OLD ORCHARD RD
Second Line	:
City	:	VESTAVIA HILLS
State	:	AL
Zip	:	35216-2298
Country	:	US
Telephone Number	:	205-978-3200
Fax Number	:	205-978-3200

Provider Business Practice Location Address
First Line	:	1936 OLD ORCHARD RD
Second Line	:
City	:	VESTAVIA HILLS
State	:	AL
Zip	:	35216-2298
Country	:	US
Telephone Number	:	205-978-3200
Fax Number	:	205-978-3200

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

Provider Enumeration Date	:	11/28/2023
Last Update Date	:	11/28/2023

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Directions to “ JORDAN WENTWORTH ” Practice Location

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