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NPI Code Detail

MEDICARE: MRS. SUSAN K JORDAN CNP

MEDICARE: MRS. SUSAN K JORDAN CNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse PractitionerCOA05329NPOH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1871580506
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SUSAN K JORDAN CNP
Provider Business Mailing Address
First Line : 4940 COTTONVILLE RD
Second Line : SUITE 100
City : JAMESTOWN
State : OH
Zip : 45335-1522
Country : US
Telephone Number : 937-675-6830
Fax Number : 937-675-6835
Provider Business Practice Location Address
First Line : 4940 COTTONVILLE RD
Second Line : SUITE 100
City : JAMESTOWN
State : OH
Zip : 45335-1522
Country : US
Telephone Number : 937-675-6830
Fax Number : 937-675-6835
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2005
Last Update Date : 06/20/2016

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