Provider Demographics
NPI:1295193886
Name:POLING, JORDAN LEI
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:LEI
Last Name:POLING
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 1:425 HAREFOOTE ST
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:OH
Mailing Address - Zip Code:43528-8567
Mailing Address - Country:US
Mailing Address - Phone:419-787-4684
Mailing Address - Fax:
Practice Address - Street 1:425 HAREFOOTE ST
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43528-8567
Practice Address - Country:US
Practice Address - Phone:419-787-4684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other