Provider Demographics
NPI:1700521002
Name:GUIDRY, JORDAN YOUNG (CRNA)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:YOUNG
Last Name:GUIDRY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:CLAIRE
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:1035 KEPLER DR
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-8320
Mailing Address - Country:US
Mailing Address - Phone:920-490-9046
Mailing Address - Fax:
Practice Address - Street 1:2845 GREENBRIER RD
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-6519
Practice Address - Country:US
Practice Address - Phone:877-229-0273
Practice Address - Fax:920-288-4863
Is Sole Proprietor?:No
Enumeration Date:2022-05-02
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WI235841-30367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program