Provider Demographics
NPI:1104215615
Name:JORDAN, SYRIANA ALYSE
Entity Type:Individual
Prefix:
First Name:SYRIANA
Middle Name:ALYSE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6511 NE 18TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-6869
Mailing Address - Country:US
Mailing Address - Phone:360-753-6082
Mailing Address - Fax:
Practice Address - Street 1:6511 NE 18TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-6869
Practice Address - Country:US
Practice Address - Phone:360-753-6082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-21
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home