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General NPI Number Information
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NPI Number | 1518403153
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Entity Type | Individual
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Provider Name | KARLA JORDAN NP
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Gender | Female
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Dates
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Enumeration Date | 01/06/2017
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Last Update Date | 11/08/2021
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Provider Practice Location Address
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Address Line | 3310 W BIG BEAVER RD
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City | TROY
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State | MI
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Zip | 48084-2809
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Country | US
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Telephone | 313-790-6271
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Fax |
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Provider Business Mailing Address
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Address Line | 20614 WASHTENAW ST
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City | HARPER WOODS
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State | MI
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Zip | 48225-2257
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Country | US
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Telephone | 313-995-5354
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 4704269221
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4704269221
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License Number State | MI
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