Provider Demographics
NPI:1013284041
Name:STEPHENS, JORDAN E (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:E
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 TRUCKEE PL
Mailing Address - Street 2:FALSE
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-5454
Mailing Address - Country:US
Mailing Address - Phone:530-220-3180
Mailing Address - Fax:
Practice Address - Street 1:8501 WEST RD
Practice Address - Street 2:
Practice Address - City:REDWOOD VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95470-9583
Practice Address - Country:US
Practice Address - Phone:707-485-6900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-18
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA797559163W00000X
CA80660163WC1500X
CA23112363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health