Healthcare Provider Details

I. General information

NPI: 1720904352
Provider Name (Legal Business Name): JORDYN TAYLOR DOOLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2026
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 RICHARD GORDON HATCHER BLVD
GARY IN
46402-6099
US

IV. Provider business mailing address

6714 MARYLAND AVE
HAMMOND IN
46323-1825
US

V. Phone/Fax

Practice location:
  • Phone: 219-886-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28292650A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: