Healthcare Provider Details

I. General information

NPI: 1093629859
Provider Name (Legal Business Name): MARIAH JORDAN BIG PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 MILLER RD
AVON LAKE OH
44012-1004
US

IV. Provider business mailing address

43625 OBERLIN ELYRIA RD
OBERLIN OH
44074-9767
US

V. Phone/Fax

Practice location:
  • Phone: 440-930-2002
  • Fax:
Mailing address:
  • Phone: 440-636-3331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0043489
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: