Provider Demographics
NPI:1508830274
Name:NORDER, JESSICA Y (CNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:Y
Last Name:NORDER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:Y
Other - Last Name:GREENLEAF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1309 10TH AVE W
Mailing Address - Street 2:
Mailing Address - City:MOBRIDGE
Mailing Address - State:SD
Mailing Address - Zip Code:57601-1146
Mailing Address - Country:US
Mailing Address - Phone:605-845-3692
Mailing Address - Fax:605-845-8252
Practice Address - Street 1:103 1ST AVENUE EAST
Practice Address - Street 2:
Practice Address - City:MC LAUGHLIN
Practice Address - State:SD
Practice Address - Zip Code:57642
Practice Address - Country:US
Practice Address - Phone:605-823-4253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-100084-051363LF0000X
SDR032835363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS14-100084-051OtherKANSAS ST BD OF NURSING
41413OtherMED B
SD0381OtherSD BOARD OF NURSING CNP
S102204OtherPTAN
ARNPOther46009
SDR032835OtherSD BOARD OF NURSING RN
SDR032835OtherSD BOARD OF NURSING RN