Provider Demographics
NPI:1144892175
Name:LEWANDOWSKI, JORDYN (APRN)
Entity type:Individual
Prefix:
First Name:JORDYN
Middle Name:
Last Name:LEWANDOWSKI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JORDYN
Other - Middle Name:
Other - Last Name:LEWANDOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4909 N GLEN PARK PLACE RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-4689
Mailing Address - Country:US
Mailing Address - Phone:309-674-7546
Mailing Address - Fax:309-691-9286
Practice Address - Street 1:4909 N GLEN PARK PLACE RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-4689
Practice Address - Country:US
Practice Address - Phone:309-674-7546
Practice Address - Fax:309-691-9286
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-09
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.023539363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty