Provider Demographics
NPI:1245262815
Name:JORDAN, JODI MARIE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JODI
Middle Name:MARIE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:JODI
Other - Middle Name:MARIE
Other - Last Name:EWIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:14229 ROUTE 35
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:PA
Practice Address - Zip Code:17086-8711
Practice Address - Country:US
Practice Address - Phone:717-694-9909
Practice Address - Fax:717-694-9912
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA003598L363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA064736NKMMedicare ID - Type Unspecified