Provider Demographics
NPI:1093321705
Name:FIELDS, JORDAN (PRS CERTIFIED)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:FIELDS
Suffix:
Gender:M
Credentials:PRS CERTIFIED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9669 PIPPIN RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-2223
Mailing Address - Country:US
Mailing Address - Phone:513-501-1200
Mailing Address - Fax:
Practice Address - Street 1:9669 PIPPIN RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-2223
Practice Address - Country:US
Practice Address - Phone:513-501-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-17
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist