Healthcare Provider Details

I. General information

NPI: 1861140402
Provider Name (Legal Business Name): DEANNA MARIE JORDAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2022
Last Update Date: 03/14/2022
Certification Date: 03/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 DUBLIN RD
COLUMBUS OH
43215-1025
US

IV. Provider business mailing address

5325 COOPER LN
PLAIN CITY OH
43064-8515
US

V. Phone/Fax

Practice location:
  • Phone: 614-488-7117
  • Fax:
Mailing address:
  • Phone: 614-946-5420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberRN427469
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: