Provider Demographics
NPI:1649638529
Name:MORDWINOW, JEADAWN
Entity type:Individual
Prefix:
First Name:JEADAWN
Middle Name:
Last Name:MORDWINOW
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:564 MOUNTAIN RANCH RD STE 5
Mailing Address - Street 2:
Mailing Address - City:SAN ANDREAS
Mailing Address - State:CA
Mailing Address - Zip Code:95249-9782
Mailing Address - Country:US
Mailing Address - Phone:916-889-3821
Mailing Address - Fax:
Practice Address - Street 1:564 MOUNTAIN RANCH RD STE 5
Practice Address - Street 2:
Practice Address - City:SAN ANDREAS
Practice Address - State:CA
Practice Address - Zip Code:95249-9782
Practice Address - Country:US
Practice Address - Phone:916-889-3821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-05
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator