Provider Demographics
NPI:1417563511
Name:JORDAN, SETH (RN)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:
Last Name:JORDAN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 586
Mailing Address - Street 2:
Mailing Address - City:SEIAD VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:96086-0586
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3233 GRIDER CREEK RD.
Practice Address - Street 2:
Practice Address - City:SEIAD VALLEY
Practice Address - State:CA
Practice Address - Zip Code:96086-0586
Practice Address - Country:US
Practice Address - Phone:530-410-1360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95170034163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse