Basic Information
| Provider Information | |||||||||
| NPI: | 1417211970 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SONDGEROTH | ||||||||
| FirstName: | JORDAN | ||||||||
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| Credential: | ACNS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1108 LAVACA ST | ||||||||
| Address2: | SUITE 110-320 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787012172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124774088 | ||||||||
| FaxNumber: | 5124821310 | ||||||||
| Practice Location | |||||||||
| Address1: | 1108 LAVACA ST | ||||||||
| Address2: | SUITE 110-320 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787012172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124774088 | ||||||||
| FaxNumber: | 5124821310 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2012 | ||||||||
| LastUpdateDate: | 06/29/2012 | ||||||||
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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 | 364SA2200X | 777401 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Adult Health |
No ID Information.