Provider Demographics
NPI:1437691151
Name:JORDAN, PASSHUN T
Entity Type:Individual
Prefix:MRS
First Name:PASSHUN
Middle Name:T
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 1:2229 N FRENCH RD
Mailing Address - Street 2:APT
Mailing Address - City:GETZVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14068-1155
Mailing Address - Country:US
Mailing Address - Phone:716-297-7414
Mailing Address - Fax:
Practice Address - Street 1:2229 N FRENCH RD
Practice Address - Street 2:APT
Practice Address - City:GETZVILLE
Practice Address - State:NY
Practice Address - Zip Code:14068-1155
Practice Address - Country:US
Practice Address - Phone:716-297-7414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-11
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY325271-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse