Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 2017017601 | MO |
Y | 2084N0402X | Child Neurologist | 2017017601 | MO |
NPI | 1386164044 |
---|---|
Provider Name | Jordan Janae Cole |
First Address | Saint Louis, MO 63110-1002 |
Second Address | Saint Louis, MO 63110-1002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2017 |
Last Update Date | 08/01/2022 |