Provider Demographics
NPI:1609131549
Name:WIEBE, JORDAN CHRISTOPHER (BA)
Entity Type:Individual
Prefix:MR
First Name:JORDAN
Middle Name:CHRISTOPHER
Last Name:WIEBE
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1841 FULTON ST STE B
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93721-1031
Mailing Address - Country:US
Mailing Address - Phone:559-288-7254
Mailing Address - Fax:
Practice Address - Street 1:3467 W SHAW AVE STE 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3223
Practice Address - Country:US
Practice Address - Phone:559-271-3096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-06
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator