Provider Demographics
NPI:1225181647
Name:JORDAN, JANA M (ATC)
Entity type:Individual
Prefix:MRS
First Name:JANA
Middle Name:M
Last Name:JORDAN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 SUNSET ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:MN
Mailing Address - Zip Code:55313-3745
Mailing Address - Country:US
Mailing Address - Phone:763-682-2376
Mailing Address - Fax:
Practice Address - Street 1:101 14TH ST NE
Practice Address - Street 2:SUITE A
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313-2927
Practice Address - Country:US
Practice Address - Phone:763-684-3899
Practice Address - Fax:763-684-3881
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN16672255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer