Provider Demographics
NPI:1396104469
Name:PEPPLE, JORDAN NICOLE
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:NICOLE
Last Name:PEPPLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 RAILWAY ST N
Mailing Address - Street 2:266
Mailing Address - City:FESSENDEN
Mailing Address - State:ND
Mailing Address - Zip Code:58438-7426
Mailing Address - Country:US
Mailing Address - Phone:701-547-3694
Mailing Address - Fax:
Practice Address - Street 1:600 RAILWAY ST N
Practice Address - Street 2:266
Practice Address - City:FESSENDEN
Practice Address - State:ND
Practice Address - Zip Code:58438-7426
Practice Address - Country:US
Practice Address - Phone:701-547-3694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-18
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker