Provider Demographics
NPI:1821089459
Name:NORDBY, JENNIFER ANN (MD)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:ANN
Last Name:NORDBY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2781 TRICOM ST
Mailing Address - Street 2:PALMETTO PEDIATRICS, PA
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9170
Mailing Address - Country:US
Mailing Address - Phone:843-797-5600
Mailing Address - Fax:843-572-4872
Practice Address - Street 1:2781 TRICOM ST
Practice Address - Street 2:PALMETTO PEDIATRICS, PA
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9170
Practice Address - Country:US
Practice Address - Phone:843-797-5600
Practice Address - Fax:843-572-4872
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2010-05-19
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Provider Licenses
StateLicense IDTaxonomies
IN01054930A208000000X
SC30457208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ING43521Medicare UPIN