Healthcare Provider Details

I. General information

NPI: 1265722417
Provider Name (Legal Business Name): KIMBERLY ANN JORDON RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

301 S 8TH ST
PHILADELPHIA PA
19106-4000
US

IV. Provider business mailing address

301 S 8TH ST
PHILADELPHIA PA
19106-4000
US

V. Phone/Fax

Practice location:
  • Phone: 215-829-6902
  • Fax:
Mailing address:
  • Phone: 215-829-6902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN225062L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: