Healthcare Provider Details

I. General information

NPI: 1033216460
Provider Name (Legal Business Name): LINDA JORDAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WVAMC 50 IRVING ST NW
WASHINGTON DC
20422-0001
US

IV. Provider business mailing address

WVAMC 50 IRVING ST NW
WASHINGTON DC
20422-0001
US

V. Phone/Fax

Practice location:
  • Phone: 202-745-8000
  • Fax:
Mailing address:
  • Phone: 202-745-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN-115048
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: