NPI 1003323502

Jordan Thaddeus Mahieu, PAC

Practitioner Physician Assistant Saint Paul, MN

Practice location

Address: 640 Jackson St # Ms 11102f, Saint Paul, MN 55101-2502
Phone: (952) 883-5129
Mailing address: PO Box 1309, Minneapolis, MN 55440-1309

Registered specialties

Physician Assistant Primary

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363A00000X

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Registry record

NPI: 1003323502
Entity type: Individual
Sex (as registered): Male
NPI issued: 5 Jan 2018
Record last updated: 5 Jan 2018

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.