JORDAN DIANE FORMAN (NPI# 1023661048) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023661048 |
| Entity Type | Individual |
| Full Name | JORDAN DIANE FORMAN |
| Credential | APRN |
| Practice Address |
1055 S Wells Ave Reno NV 89502-2550 |
| Practice Telephone | 7753296300 |
| Practice Fax Number | 7753489896 |
| Mailing Telephone | 7753296300 |
| Mailing Fax Number | 7753489896 |
| Enumeration Date | 2019-07-18 |
| Last Update Date | 2019-07-18 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
821587 | NV | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1055 S WELLS AVE |
| City | RENO |
| State | NV |
| Zip Code | 89502-2550 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346233392 | Steven A Shane | Pediatrics | 1055 S Wells Ave, Reno, NV 89502-2550 | 2005-08-24 |
| 1285233486 | Melanie Hacklander | Nurse Practitioner | 1055 S Wells Ave, Reno, NV 89502-2550 | 2020-10-20 |
| 1770117756 | Elizabeth Patricia Lewis | Registered Nurse | 1055 S Wells Ave, Reno, NV 89502-2550 | 2020-02-27 |
| 1407492853 | Lucia Amanda Sanchez | Physician Assistant | 1055 S Wells Ave, Reno, NV 89502-2550 | 2019-11-20 |
| 1760030712 | Luis Fernando Rodriguez | Physician Assistant | 1055 S Wells Ave, Reno, NV 89502-2550 | 2019-09-03 |
| 1841844511 | Aaron V Blackham | Social Worker | 1055 S Wells Ave, Reno, NV 89502-2550 | 2019-07-30 |
| 1174182166 | Cecilia Bowers | Physician Assistant | 1055 S Wells Ave, Reno, NV 89502-2550 | 2019-06-12 |
| 1649752106 | Kristyn Mcdougall | Nurse Practitioner | 1055 S Wells Ave, Reno, NV 89502-2550 | 2018-08-31 |
| 1326532714 | Caitlin Alexandra White | Family Medicine | 1055 S Wells Ave, Reno, NV 89502-2550 | 2018-06-19 |
| 1992203871 | Kelsey Maxim | Pharmacist | 1055 S Wells Ave, Reno, NV 89502-2550 | 2018-01-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992314264 | State of Nevada | Community/Behavioral Health | 4600 Kietzke Lane Bldg D, Reno, NV 89502 | 2020-07-23 |
| 1447879259 | Ryan Johnson | Student in an Organized Health Care Education/Training Program | 1155 Mill St. W-11, Reno, NV 89502 | 2020-04-11 |
| 1396378063 | Domingko Loney | Chore Provider | 1325 Air Motive Wat St 262, Reno, NV 89502 | 2020-02-20 |
| 1053954842 | Derek Craig | Home Health Aide | 1000 Havard Way #29, Reno, NV 89502 | 2019-10-24 |
| 1477108124 | Marisa Rachael Traversie | Nurse Practitioner | 910 Vista Boulevard, Sparks, NV 89502 | 2019-08-08 |
| 1912564675 | Patrick Llewellyn Merrill | Social Worker | 975 Kirman Ave - Ch 116, Reno, NV 89502 | 2019-05-28 |
| 1881154706 | Naresh Kumar Veerabattini | Student in an Organized Health Care Education/Training Program | 1155 Mill St, Renown Regional Medical Center, W11 Academic Department Offices, Reno, NV 89502 | 2019-03-25 |
| 1053899187 | Daphne London | Behavioral Analyst | 1325 Airmotive Way Ste 260, Reno, NV 89502 | 2018-07-31 |
| 1790271609 | Jennifer J Padolina | Optometrist | 2296 Kietzke Ln, Reno, NV 89502 | 2018-07-03 |
| 1336630185 | Lindsey Cherie Cooper | Technician | 3563 Sol Grande Ct, Reno, NV 89502 | 2018-05-27 |
| Find all providers in zip 89502 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417556705 | Malina Josephine Ruiz | Nurse Practitioner | 1500 E 2nd St Ste 400p1, Reno, NV 89502-1262 | 2020-10-19 |
| 1902410830 | Christina Ann Krainbrink | Nurse Practitioner | 2094 Long Meadow Dr, Reno, NV 89521-4506 | 2020-09-08 |
| 1598382244 | Kathy Goldsworthy | Nurse Practitioner | 2211 Enterprise Rd, Reno, NV 89521-7438 | 2020-06-29 |
| 1487286654 | Noelle Marie Davis-marinaccio | Nurse Practitioner | 5570 Longley Lane, Reno, NV 89511 | 2020-02-06 |
| 1659834091 | Janet Choi | Nurse Practitioner | 6629 S Virginia St, Reno, NV 89511-1168 | 2019-04-11 |
| 1295218691 | Thrive Enterprises LLC | Nurse Practitioner | 7111 S Virginia St Ste A12, Reno, NV 89511-1135 | 2018-09-11 |
| 1932688280 | Gerald Justin Enox | Nurse Practitioner | 370 Bible Camp Rd, Reno, TX 75462 | 2018-08-08 |
| 1750860995 | Darci Page | Nurse Practitioner | 500 Damonte Ranch Pkwy Ste 703, Reno, NV 89521-3911 | 2018-08-08 |
| 1528573227 | Jennifer Ann Woolf | Nurse Practitioner | 8165 Fire Opal Lane, Reno, NV 89506 | 2017-12-05 |
| 1912422957 | Trucare Health Services, LLC | Nurse Practitioner | 9930 Rising Sun Ct, Reno, NV 89506 | 2017-08-10 |
| Find all providers in RENO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.