Provider Demographics
NPI:1043868441
Name:WILSON-JORDAN, SHIRLEY ANN (CPC)
Entity Type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:ANN
Last Name:WILSON-JORDAN
Suffix:
Gender:F
Credentials:CPC
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 32521
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44132-0521
Mailing Address - Country:US
Mailing Address - Phone:216-358-5346
Mailing Address - Fax:
Practice Address - Street 1:982 STEVENSON RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44110-3176
Practice Address - Country:US
Practice Address - Phone:216-358-5346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No343800000XTransportation ServicesSecured Medical Transport (VAN)