Provider Demographics
NPI:1003685835
Name:STEVENSON, JORDAN IVY RHIANNON
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:IVY RHIANNON
Last Name:STEVENSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 DISCOVERY DR
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-3946
Mailing Address - Country:US
Mailing Address - Phone:740-771-1860
Mailing Address - Fax:
Practice Address - Street 1:111 DISCOVERY DR
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-3946
Practice Address - Country:US
Practice Address - Phone:740-771-1860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health