Provider Demographics
NPI:1407103849
Name:LORDAN, JOHANNAH ELIZABETH
Entity Type:Individual
Prefix:
First Name:JOHANNAH
Middle Name:ELIZABETH
Last Name:LORDAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOHANNAH
Other - Middle Name:ELIZABETH
Other - Last Name:PAYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:34 HAVERHILL ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01841-2884
Mailing Address - Country:US
Mailing Address - Phone:978-686-0090
Mailing Address - Fax:978-681-5963
Practice Address - Street 1:34 HAVERHILL ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01841-2884
Practice Address - Country:US
Practice Address - Phone:978-686-0090
Practice Address - Fax:978-681-5963
Is Sole Proprietor?:No
Enumeration Date:2012-08-03
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2268620363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily