Provider Demographics
NPI:1265003701
Name:CHURCH, JORDAN KENDALL (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:KENDALL
Last Name:CHURCH
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7528 MANULELE PL
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-2941
Mailing Address - Country:US
Mailing Address - Phone:808-492-6188
Mailing Address - Fax:
Practice Address - Street 1:7528 MANULELE PL
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96825-2941
Practice Address - Country:US
Practice Address - Phone:808-492-6188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN-83171163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse