1902471634 NPI number — JOURDON QUINN JAYE WICHMAN APRN-CNM

Table of content: DR. VISHRUTI SHAH DMD (NPI 1942407945)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902471634 NPI number — JOURDON QUINN JAYE WICHMAN APRN-CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WICHMAN
Provider First Name:
JOURDON
Provider Middle Name:
QUINN JAYE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN-CNM
Provider Gender Code:
F

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:
1902471634
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 81
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINIFRED
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59489-0081
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-390-1276
Provider Business Mailing Address Fax Number:
800-853-6531

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PO BOX 81
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINIFRED
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59489-0081
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-390-1276
Provider Business Practice Location Address Fax Number:
800-853-6531
Provider Enumeration Date:
05/25/2021

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: 163WX0003X , with the licence number:  NUR-RN-LIC-70073 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367A00000X , with the licence number: NUR-APRN-LIC-176408 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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