Provider Demographics
NPI:1932776549
Name:JORDAN, BRITON (DNAP, CRNA)
Entity Type:Individual
Prefix:DR
First Name:BRITON
Middle Name:
Last Name:JORDAN
Suffix:
Gender:M
Credentials:DNAP, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 SAINT ANDREW ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-3828
Mailing Address - Country:US
Mailing Address - Phone:605-431-0700
Mailing Address - Fax:
Practice Address - Street 1:56 SAINT ANDREW ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-3828
Practice Address - Country:US
Practice Address - Phone:605-431-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCR001075367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered