Provider Demographics
NPI:1851603294
Name:TELLER, JORDAN B (MSN)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:B
Last Name:TELLER
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:ELAINE
Other - Last Name:BELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2900 12TH AVE N STE 160W
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-7508
Mailing Address - Country:US
Mailing Address - Phone:406-237-8500
Mailing Address - Fax:406-237-8501
Practice Address - Street 1:2900 12TH AVE N STE 160W
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-7508
Practice Address - Country:US
Practice Address - Phone:406-237-8500
Practice Address - Fax:406-237-8501
Is Sole Proprietor?:No
Enumeration Date:2010-07-13
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT34680363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT34680OtherLICENSE