Provider Demographics
NPI:1417610601
Name:MONDT, JORDAN ANN (DNP, APRN, CPNP-PC)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:ANN
Last Name:MONDT
Suffix:
Gender:F
Credentials:DNP, APRN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9475 LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-9034
Mailing Address - Country:US
Mailing Address - Phone:314-650-0230
Mailing Address - Fax:
Practice Address - Street 1:310 SMITH AVE N STE 480
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2377
Practice Address - Country:US
Practice Address - Phone:314-577-5609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-15
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021041457363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty