Provider Demographics
NPI:1902578313
Name:VERRALL, JORDAN RAE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:JORDAN
Middle Name:RAE
Last Name:VERRALL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:JORDAN
Other - Middle Name:RAE
Other - Last Name:ARTIERI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3719 UNION RD STE 218
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-4251
Mailing Address - Country:US
Mailing Address - Phone:716-206-1503
Mailing Address - Fax:
Practice Address - Street 1:7300 PORTER RD
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-5716
Practice Address - Country:US
Practice Address - Phone:716-298-5862
Practice Address - Fax:716-298-5896
Is Sole Proprietor?:No
Enumeration Date:2021-10-04
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY347799363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner