Provider Demographics
NPI:1508107129
Name:BECKER, JORDAN (NP)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:BECKER
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9485 MENTOR AVENUE
Mailing Address - Street 2:SUITE 210 PRIMEHEALTH
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-8723
Mailing Address - Country:US
Mailing Address - Phone:440-205-5883
Mailing Address - Fax:440-205-5746
Practice Address - Street 1:9485 MENTOR AVE STE 210
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-8723
Practice Address - Country:US
Practice Address - Phone:440-255-5571
Practice Address - Fax:440-205-5744
Is Sole Proprietor?:No
Enumeration Date:2013-03-06
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH14339-NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health