Provider Demographics
NPI:1467975458
Name:HAISLEY, JORDAN NICOLE (NRAEMT, MCP)
Entity Type:Individual
Prefix:MRS
First Name:JORDAN
Middle Name:NICOLE
Last Name:HAISLEY
Suffix:
Gender:F
Credentials:NRAEMT, MCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W ROOSEVELT ST
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-1865
Mailing Address - Country:US
Mailing Address - Phone:765-228-8035
Mailing Address - Fax:
Practice Address - Street 1:201 W ROOSEVELT ST
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-1865
Practice Address - Country:US
Practice Address - Phone:765-228-8035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106E00000X, 106S00000X, 246Y00000X
IN3089-0062146M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Y00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health Information
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, Intermediate