Provider Demographics
NPI:1902471634
Name:WICHMAN, JOURDON QUINN JAYE (APRN-CNM)
Entity Type:Individual
Prefix:
First Name:JOURDON
Middle Name:QUINN JAYE
Last Name:WICHMAN
Suffix:
Gender:F
Credentials:APRN-CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1114 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:MT
Mailing Address - Zip Code:59457-2302
Mailing Address - Country:US
Mailing Address - Phone:406-350-0505
Mailing Address - Fax:
Practice Address - Street 1:1114 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:MT
Practice Address - Zip Code:59457-2302
Practice Address - Country:US
Practice Address - Phone:406-350-0505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-RN-LIC-70073163WX0003X
MTNUR-APRN-LIC-176408367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient