Provider Demographics
NPI:1902214521
Name:STANCOMBE, JORDAN (PA)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:STANCOMBE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 E DAHLIA AVE STE M-B
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-6463
Mailing Address - Country:US
Mailing Address - Phone:907-745-4488
Mailing Address - Fax:907-745-4487
Practice Address - Street 1:425 E DAHLIA AVE STE M-B
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-6463
Practice Address - Country:US
Practice Address - Phone:907-745-4488
Practice Address - Fax:907-745-4487
Is Sole Proprietor?:No
Enumeration Date:2014-07-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1836363A00000X
AK127956363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant