Provider Demographics
NPI:1508501636
Name:JORDAN, VERGENER
Entity Type:Individual
Prefix:MS
First Name:VERGENER
Middle Name:
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 1:5303 E TEXAS ST LOT 14
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-6947
Mailing Address - Country:US
Mailing Address - Phone:318-510-5233
Mailing Address - Fax:
Practice Address - Street 1:5303 E TEXAS ST LOT 14
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-6947
Practice Address - Country:US
Practice Address - Phone:318-510-5233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker