Provider Demographics
NPI:1093499600
Name:BONEY, JORDAN ANN
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:ANN
Last Name:BONEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10492 BOCEK LN
Mailing Address - Street 2:
Mailing Address - City:ARGONNE
Mailing Address - State:WI
Mailing Address - Zip Code:54511-8933
Mailing Address - Country:US
Mailing Address - Phone:715-889-9585
Mailing Address - Fax:
Practice Address - Street 1:1630 CHIPPEWA DR
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-9503
Practice Address - Country:US
Practice Address - Phone:715-361-5480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14086-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner