Provider Demographics
NPI:1548776537
Name:JORDAN, KATHLEEN P (CD(DONA))
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:P
Last Name:JORDAN
Suffix:
Gender:F
Credentials:CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 BANNEKER DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92114-4705
Mailing Address - Country:US
Mailing Address - Phone:619-961-5210
Mailing Address - Fax:
Practice Address - Street 1:806 BANNEKER DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92114-4705
Practice Address - Country:US
Practice Address - Phone:619-961-5210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-28
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula