Basic Information
| Provider Information | |||||||||
| NPI: | 1073533139 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JORDA | ||||||||
| FirstName: | ARLYS | ||||||||
| MiddleName: | |||||||||
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| Credential: | CRNA | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | JORDA | ||||||||
| OtherFirstName: | ARLYS | ||||||||
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| OtherCredential: | CRNA | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 30 7TH ST W | ||||||||
| Address2: | |||||||||
| City: | DICKINSON | ||||||||
| State: | ND | ||||||||
| PostalCode: | 586014335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7014564000 | ||||||||
| FaxNumber: | 7014564800 | ||||||||
| Practice Location | |||||||||
| Address1: | 30 7TH ST W | ||||||||
| Address2: | |||||||||
| City: | DICKINSON | ||||||||
| State: | ND | ||||||||
| PostalCode: | 586014335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7014564000 | ||||||||
| FaxNumber: | 7014564800 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | R21055 | ND | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.