Provider Demographics
NPI:1134714884
Name:ELLER, JORDAN MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:MARIE
Last Name:ELLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1356 126TH RD
Mailing Address - Street 2:
Mailing Address - City:STROMSBURG
Mailing Address - State:NE
Mailing Address - Zip Code:68666-6240
Mailing Address - Country:US
Mailing Address - Phone:402-764-2491
Mailing Address - Fax:
Practice Address - Street 1:1356 126TH RD
Practice Address - Street 2:
Practice Address - City:STROMSBURG
Practice Address - State:NE
Practice Address - Zip Code:68666-6240
Practice Address - Country:US
Practice Address - Phone:402-764-2491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2574363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant