Provider Demographics
NPI:1073974374
Name:MALACE, JORDANA SUSANNE (RN, BSN)
Entity Type:Individual
Prefix:MRS
First Name:JORDANA
Middle Name:SUSANNE
Last Name:MALACE
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:JORDANA
Other - Middle Name:SUSANNE
Other - Last Name:JARRETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN
Mailing Address - Street 1:9040 REID STREET, ATTN: MCHJ-CLQ-C
Mailing Address - Street 2:MADIGAN ARMY MEDICAL CENTER
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431-1000
Mailing Address - Country:US
Mailing Address - Phone:253-968-1110
Mailing Address - Fax:877-874-1031
Practice Address - Street 1:9040 REID STREET, ATTN: MCHJ-CLQ-C
Practice Address - Street 2:MADIGAN ARMY MEDICAL CENTER
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-1000
Practice Address - Country:US
Practice Address - Phone:253-968-1110
Practice Address - Fax:877-874-1031
Is Sole Proprietor?:No
Enumeration Date:2016-03-14
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-152002163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse