Provider Demographics
NPI:1508199902
Name:JORDAN, PAULA (PSR)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:PSR
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 518
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-0518
Mailing Address - Country:US
Mailing Address - Phone:505-865-3350
Mailing Address - Fax:505-865-4739
Practice Address - Street 1:735 DON PASQUAL RD NW
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-8493
Practice Address - Country:US
Practice Address - Phone:505-865-3350
Practice Address - Fax:505-865-4739
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator