Provider Demographics
NPI:1801498282
Name:RADEL, JORDAN DANIELLE (APRN)
Entity type:Individual
Prefix:MRS
First Name:JORDAN
Middle Name:DANIELLE
Last Name:RADEL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9107 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-2222
Mailing Address - Country:US
Mailing Address - Phone:402-813-7031
Mailing Address - Fax:
Practice Address - Street 1:312 OLSON DR STE 101
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-2981
Practice Address - Country:US
Practice Address - Phone:402-933-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE113399363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner