Provider Demographics
NPI:1962885707
Name:GREINER, JORDAN LEA (PA-C)
Entity type:Individual
Prefix:MS
First Name:JORDAN
Middle Name:LEA
Last Name:GREINER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:LEA
Other - Last Name:ESBECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2605 WASHINGTON ST
Mailing Address - Street 2:IOWA DERMATOLOGY INC
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219-7924
Mailing Address - Country:US
Mailing Address - Phone:641-620-9119
Mailing Address - Fax:641-613-1305
Practice Address - Street 1:2605 WASHINGTON ST
Practice Address - Street 2:IOWA DERMATOLOGY INC
Practice Address - City:PELLA
Practice Address - State:IA
Practice Address - Zip Code:50219-7924
Practice Address - Country:US
Practice Address - Phone:641-620-9119
Practice Address - Fax:641-613-1305
Is Sole Proprietor?:No
Enumeration Date:2015-06-29
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1127557OtherNATIONAL COMMISSION ON CERTIFICATION OF PHYSICIAN ASSISTANTS