Healthcare Provider Details

I. General information

NPI: 1013207323
Provider Name (Legal Business Name): MAUREEN BAKER JORDAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2011
Last Update Date: 01/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20346 ENNIS RD
GEORGETOWN DE
19947-4108
US

IV. Provider business mailing address

31 HOOSIER ST
SELBYVILLE DE
19975-9300
US

V. Phone/Fax

Practice location:
  • Phone: 302-856-1926
  • Fax: 302-856-1950
Mailing address:
  • Phone: 302-436-1000
  • Fax: 302-856-1950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberL1-0035185
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: