Provider Demographics
NPI:1871274738
Name:STENSGARD, JORDAN JON (MSN, APNP, FNP-C)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:JON
Last Name:STENSGARD
Suffix:
Gender:M
Credentials:MSN, APNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2408 15TH PL
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53140-4943
Mailing Address - Country:US
Mailing Address - Phone:262-331-4150
Mailing Address - Fax:
Practice Address - Street 1:8311 16TH ST
Practice Address - Street 2:
Practice Address - City:STURTEVANT
Practice Address - State:WI
Practice Address - Zip Code:53177-1974
Practice Address - Country:US
Practice Address - Phone:262-260-3671
Practice Address - Fax:262-260-5013
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14261-33363LX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health