Provider Demographics
NPI:1508622093
Name:JORDAN, CARMALITA M
Entity Type:Individual
Prefix:MS
First Name:CARMALITA
Middle Name:M
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 1:7029 HIGH BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-5237
Mailing Address - Country:US
Mailing Address - Phone:301-821-2966
Mailing Address - Fax:
Practice Address - Street 1:611 EDGEWOOD ST NE APT 1004
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-4261
Practice Address - Country:US
Practice Address - Phone:202-705-7763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant