Provider Demographics
NPI:1366806903
Name:IREMONGER, JORDAN (PARAMEDIC, NREMT-P)
Entity type:Individual
Prefix:MR
First Name:JORDAN
Middle Name:
Last Name:IREMONGER
Suffix:
Gender:M
Credentials:PARAMEDIC, NREMT-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24102 NE 50TH AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:WA
Mailing Address - Zip Code:98642-8124
Mailing Address - Country:US
Mailing Address - Phone:360-281-3411
Mailing Address - Fax:
Practice Address - Street 1:5475 NE DAWSON CREEK DR
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-5797
Practice Address - Country:US
Practice Address - Phone:503-648-6657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-10
Last Update Date:2016-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR143255146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic