Provider Demographics
NPI:1497398309
Name:WERDERITCH, JORDYN O'ROURKE (NP)
Entity Type:Individual
Prefix:MRS
First Name:JORDYN
Middle Name:O'ROURKE
Last Name:WERDERITCH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:JORDYN
Other - Middle Name:ELIZABETH
Other - Last Name:O'ROURKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1100 36TH AVE
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-7127
Mailing Address - Country:US
Mailing Address - Phone:309-743-6700
Mailing Address - Fax:309-764-2042
Practice Address - Street 1:1100 36TH AVE
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-7127
Practice Address - Country:US
Practice Address - Phone:309-743-6700
Practice Address - Fax:309-764-2042
Is Sole Proprietor?:No
Enumeration Date:2019-10-23
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9674-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner