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General NPI Number Information
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NPI Number | 1558679936
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Entity Type | Individual
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Provider Name | SANDRA S JORDAN M.ED.
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Gender | Female
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Dates
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Enumeration Date | 09/19/2010
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Last Update Date | 09/19/2010
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Provider Practice Location Address
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Address Line | 106 PAILIN CREEK RD
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City | ELIZABETH CITY
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State | NC
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Zip | 27909-2924
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Country | US
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Telephone | 252-339-6842
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Fax | 252-330-2001
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Provider Business Mailing Address
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Address Line | PO BOX 2213
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City | ELIZABETH CITY
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State | NC
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Zip | 27906-2213
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Country | US
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Telephone | 252-339-6842
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Fax | 252-330-2001
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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