Provider Demographics
NPI:1659845907
Name:JORDAN, JENNIFER (ARRT(R))
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:ARRT(R)
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:HAMBY-JORDAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARRT(R)
Mailing Address - Street 1:1058 COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:NEW TOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58763-9112
Mailing Address - Country:US
Mailing Address - Phone:701-627-7680
Mailing Address - Fax:701-627-3050
Practice Address - Street 1:1058 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:NEW TOWN
Practice Address - State:ND
Practice Address - Zip Code:58763-9112
Practice Address - Country:US
Practice Address - Phone:701-627-7680
Practice Address - Fax:701-627-3050
Is Sole Proprietor?:No
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND14402085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology