Provider Demographics
NPI:1902471634
Name:WICHMAN, JOURDON QUINN JAYE (APRN-CNM)
Entity type:Individual
Prefix:
First Name:JOURDON
Middle Name:QUINN JAYE
Last Name:WICHMAN
Suffix:
Gender:F
Credentials:APRN-CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 81
Mailing Address - Street 2:
Mailing Address - City:WINIFRED
Mailing Address - State:MT
Mailing Address - Zip Code:59489-0081
Mailing Address - Country:US
Mailing Address - Phone:406-390-1276
Mailing Address - Fax:800-853-6531
Practice Address - Street 1:PO BOX 81
Practice Address - Street 2:
Practice Address - City:WINIFRED
Practice Address - State:MT
Practice Address - Zip Code:59489-0081
Practice Address - Country:US
Practice Address - Phone:406-390-1276
Practice Address - Fax:800-853-6531
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2024-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-RN-LIC-70073163WX0003X
MTNUR-APRN-LIC-176408367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient