Provider Demographics
NPI:1437517422
Name:JORDAN, NAUTASHAE S
Entity Type:Individual
Prefix:
First Name:NAUTASHAE
Middle Name:S
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 1:2012 CARPENTER DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45239-4745
Mailing Address - Country:US
Mailing Address - Phone:513-801-4460
Mailing Address - Fax:
Practice Address - Street 1:2012 CARPENTER DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45239-4745
Practice Address - Country:US
Practice Address - Phone:513-801-4460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-04
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 127942164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse