Basic Information
| Provider Information | |||||||||
| NPI: | 1215673249 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CATAPANO | ||||||||
| FirstName: | JORDYN | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 33606 DUNKLIN RD | ||||||||
| Address2: | |||||||||
| City: | SUNRISE BEACH | ||||||||
| State: | MO | ||||||||
| PostalCode: | 650792002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8455914026 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1102 W 32ND ST | ||||||||
| Address2: | |||||||||
| City: | JOPLIN | ||||||||
| State: | MO | ||||||||
| PostalCode: | 648043503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4173471111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2022 | ||||||||
| LastUpdateDate: | 05/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.