MEDICARE: ANGELA SUE JORDAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747A0650X	Attendant Care Provider	RF895684	OH

General Provider Information

NPI Number	:	1215872940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA SUE JORDAN

Provider Business Mailing Address
First Line	:	304 WILSON ST
Second Line	:
City	:	PORTSMOUTH
State	:	OH
Zip	:	45662-5672
Country	:	US
Telephone Number	:	740-935-7236
Fax Number	:

Provider Business Practice Location Address
First Line	:	304 WILSON ST
Second Line	:
City	:	PORTSMOUTH
State	:	OH
Zip	:	45662-5672
Country	:	US
Telephone Number	:	740-935-7236
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2026
Last Update Date	:	04/20/2026

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Directions to “ ANGELA SUE JORDAN ” Practice Location

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