Healthcare Provider Details

I. General information

NPI: 1447114806
Provider Name (Legal Business Name): JORDAN LEE WHITE RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3511 WOODRIDGE RD
CLEVELAND HEIGHTS OH
44121-1533
US

IV. Provider business mailing address

3511 WOODRIDGE RD
CLEVELAND HEIGHTS OH
44121-1533
US

V. Phone/Fax

Practice location:
  • Phone: 757-335-1971
  • Fax:
Mailing address:
  • Phone: 757-335-1971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.539235
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: