1497398309 NPI number — MRS. JORDYN O'ROURKE WERDERITCH NP

Table of content: MRS. JORDYN O'ROURKE WERDERITCH NP (NPI 1497398309)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497398309 NPI number — MRS. JORDYN O'ROURKE WERDERITCH NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WERDERITCH
Provider First Name:
JORDYN
Provider Middle Name:
O'ROURKE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
O'ROURKE
Provider Other First Name:
JORDYN
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1497398309
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/04/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1100 36TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOLINE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61265-7127
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-743-6700
Provider Business Mailing Address Fax Number:
309-764-2042

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 36TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOLINE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61265-7127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-743-6700
Provider Business Practice Location Address Fax Number:
309-764-2042
Provider Enumeration Date:
10/23/2019

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: 363L00000X , with the licence number:  9674-33 , 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)





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