Provider Demographics
NPI:1639837735
Name:CIAMBRONE, JORDAN T (NBC-HWC)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:T
Last Name:CIAMBRONE
Suffix:
Gender:F
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 LINCOLN AVE UPPR
Mailing Address - Street 2:
Mailing Address - City:MANITOU SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80829-1882
Mailing Address - Country:US
Mailing Address - Phone:602-315-6744
Mailing Address - Fax:
Practice Address - Street 1:30 LINCOLN AVE UPPR
Practice Address - Street 2:
Practice Address - City:MANITOU SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80829-1882
Practice Address - Country:US
Practice Address - Phone:602-315-6744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-06
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COA-3275713