Provider Demographics
NPI:1275388647
Name:JORDAN, SHAWNTIERE
Entity Type:Individual
Prefix:
First Name:SHAWNTIERE
Middle Name:
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 1:48 SAFER PLZ
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44306-4031
Mailing Address - Country:US
Mailing Address - Phone:330-208-6770
Mailing Address - Fax:
Practice Address - Street 1:48 SAFER PLZ
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44306-4031
Practice Address - Country:US
Practice Address - Phone:330-208-6770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide