1871274738 NPI number — JORDAN JON STENSGARD MSN, APNP, FNP-C

Table of content: JORDAN JON STENSGARD MSN, APNP, FNP-C (NPI 1871274738)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871274738 NPI number — JORDAN JON STENSGARD MSN, APNP, FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STENSGARD
Provider First Name:
JORDAN
Provider Middle Name:
JON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN, APNP, FNP-C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871274738
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/25/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2408 15TH PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENOSHA
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53140-4943
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-331-4150
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8311 16TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STURTEVANT
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53177-1974
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-260-3671
Provider Business Practice Location Address Fax Number:
262-260-5013
Provider Enumeration Date:
07/25/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LX0106X , with the licence number:  14261-33 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com