Provider Demographics
NPI:1750272597
Name:POLLEY, JORDAN FAITH (FNP-C)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:FAITH
Last Name:POLLEY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:FAITH
Other - Last Name:NOURSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:146 N EAGLE ST
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54902-4124
Mailing Address - Country:US
Mailing Address - Phone:920-379-8886
Mailing Address - Fax:
Practice Address - Street 1:1818 N MEADE ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-3454
Practice Address - Country:US
Practice Address - Phone:920-731-4101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-10
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17064-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily