Provider Demographics
NPI:1649692732
Name:WARNSHOLZ, JORDAN (PA)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:WARNSHOLZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14477 CABERFAE HWY
Mailing Address - Street 2:
Mailing Address - City:WELLSTON
Mailing Address - State:MI
Mailing Address - Zip Code:49689-9315
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14477 CABERFAE HWY
Practice Address - Street 2:
Practice Address - City:WELLSTON
Practice Address - State:MI
Practice Address - Zip Code:49689-9315
Practice Address - Country:US
Practice Address - Phone:231-848-4777
Practice Address - Fax:231-848-4027
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-09
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI363A00000X
MI5601006903363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant