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General NPI Number Information
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NPI Number | 1356199913
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Entity Type | Individual
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Provider Name | JORDAN IBRAHIM CUSICK
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Gender | Male
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Dates
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Enumeration Date | 05/08/2024
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Last Update Date | 04/22/2026
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Provider Practice Location Address
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Address Line | 1550 N 115TH ST
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City | SEATTLE
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State | WA
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Zip | 98133-8401
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Country | US
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Telephone | 877-694-4677
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Fax |
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Provider Business Mailing Address
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Address Line | 3546 S GRAHAM ST
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City | SEATTLE
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State | WA
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Zip | 98118-3126
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Country | US
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Telephone | 626-993-4988
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WM0705X
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Taxonomy Name | Medical-Surgical Registered Nurse
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License Number | RN61004355
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | AP70035123
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License Number State | WA
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