Provider Demographics
NPI:1184376279
Name:MCGUIRE, JORDAN K (NP)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:K
Last Name:MCGUIRE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 779
Mailing Address - Street 2:
Mailing Address - City:TAWAS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48764-0779
Mailing Address - Country:US
Mailing Address - Phone:989-728-4211
Mailing Address - Fax:989-728-4334
Practice Address - Street 1:3190 NORTHRIDGE RD
Practice Address - Street 2:
Practice Address - City:HALE
Practice Address - State:MI
Practice Address - Zip Code:48739-9276
Practice Address - Country:US
Practice Address - Phone:989-728-4211
Practice Address - Fax:989-728-4334
Is Sole Proprietor?:No
Enumeration Date:2022-01-20
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704350549163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse