Provider Demographics
NPI:1326742818
Name:BAXTER, JORDAN HUBERT (CNA)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:HUBERT
Last Name:BAXTER
Suffix:
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6385 DAWNFIELD LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23231-5335
Mailing Address - Country:US
Mailing Address - Phone:804-588-2018
Mailing Address - Fax:
Practice Address - Street 1:2300 CEDARFIELD PKWY
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233-1936
Practice Address - Country:US
Practice Address - Phone:804-474-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1401217293376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide