Basic Information
| Provider Information | |||||||||
| NPI: | 1851968739 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GARY | ||||||||
| FirstName: | JORDEN | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 736 N 2850 W | ||||||||
| Address2: | |||||||||
| City: | HURRICANE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 847371360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4355747827 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2811 TIETON DR | ||||||||
| Address2: | |||||||||
| City: | YAKIMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989023761 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5095758000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2021 | ||||||||
| LastUpdateDate: | 06/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | AP61183586 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.