=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760762645
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CATHLEEN M JORDAN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/23/2011
-----------------------------------------------------
Last Update Date | 04/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 134 S RIVER DR
-----------------------------------------------------
City | WILLIAMSTOWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08094-2542
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-338-8222
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2208 EVERGREEN DR
-----------------------------------------------------
City | HAMMONTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08037-2843
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-338-8222
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 364SA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Clinical Nurse Specialist
-----------------------------------------------------
License Number | 26NO11400900
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 364S00000X
-----------------------------------------------------
Taxonomy Name | Clinical Nurse Specialist
-----------------------------------------------------
License Number | 26NJ00344500
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------