Healthcare Provider Details

I. General information

NPI: 1427577360
Provider Name (Legal Business Name): TANIER JORDAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2017
Last Update Date: 07/21/2022
Certification Date: 05/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 NW BUCKLIN HILL RD STE 224
SILVERDALE WA
98383-8365
US

IV. Provider business mailing address

5455 ALMIRA DR NE
BREMERTON WA
98311-8330
US

V. Phone/Fax

Practice location:
  • Phone: 909-725-5899
  • Fax:
Mailing address:
  • Phone: 360-415-5870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: