Provider Demographics
NPI:1154652048
Name:JORDAN, NANCY S (RN, CRNA)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:S
Last Name:JORDAN
Suffix:
Gender:F
Credentials:RN, CRNA
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:SPIEWAK
Other - Last Name:OBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2449 W FOSTER AVE
Mailing Address - Street 2:APT GE
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-7325
Mailing Address - Country:US
Mailing Address - Phone:773-720-5590
Mailing Address - Fax:
Practice Address - Street 1:5145 N CALIFORNIA AVE
Practice Address - Street 2:NORTHSHORE MEDICAL GROUP
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3661
Practice Address - Country:US
Practice Address - Phone:773-293-5486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-17
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041342691163WC0200X
IL209007985367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine