Provider Demographics
NPI:1013411594
Name:JORDAN, PATRICIA MARIE (RN)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:MARIE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 NE MORGAN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-2344
Mailing Address - Country:US
Mailing Address - Phone:208-791-3593
Mailing Address - Fax:503-505-9273
Practice Address - Street 1:21004 S HIGHWAY 213
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-9192
Practice Address - Country:US
Practice Address - Phone:503-245-4175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health