Provider Demographics
NPI:1346275062
Name:JORDE, JEANA (PA)
Entity Type:Individual
Prefix:
First Name:JEANA
Middle Name:
Last Name:JORDE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 688
Mailing Address - Street 2:
Mailing Address - City:CANDO
Mailing Address - State:ND
Mailing Address - Zip Code:58324-0688
Mailing Address - Country:US
Mailing Address - Phone:701-968-2541
Mailing Address - Fax:701-968-2574
Practice Address - Street 1:HYW 281 N
Practice Address - Street 2:
Practice Address - City:CANDO
Practice Address - State:ND
Practice Address - Zip Code:58324
Practice Address - Country:US
Practice Address - Phone:701-968-2541
Practice Address - Fax:701-968-2574
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDPAC0275363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND24226OtherBCBS PROVIDER #
ND71287Medicaid
MN849658700Medicaid
ND24119OtherBCBS PROVIDER #
ND24226OtherBCBS PROVIDER #
MN849658700Medicaid
P58643Medicare UPIN