Provider Demographics
NPI:1033461256
Name:JORDAN, YVONNE MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:MARIE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 31
Mailing Address - Street 2:
Mailing Address - City:DEPAUVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13632-0031
Mailing Address - Country:US
Mailing Address - Phone:315-686-2989
Mailing Address - Fax:
Practice Address - Street 1:32413 NY RTE. 12
Practice Address - Street 2:
Practice Address - City:DEPAUVILLE
Practice Address - State:NY
Practice Address - Zip Code:13632-0031
Practice Address - Country:US
Practice Address - Phone:315-686-2989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY170055164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse