Provider Demographics
NPI:1205518446
Name:STONE, JORDAN (FNP-C)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:STONE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1480 WESTWOOD DR APT 37
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-7820
Mailing Address - Country:US
Mailing Address - Phone:920-680-4526
Mailing Address - Fax:
Practice Address - Street 1:2720 PLAZA DR STE 1100
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4169
Practice Address - Country:US
Practice Address - Phone:715-847-2472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14403-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner