Provider Demographics
NPI:1568146579
Name:JORDAN, ROWAN MARIE (NUTRITIONIST)
Entity Type:Individual
Prefix:
First Name:ROWAN
Middle Name:MARIE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:NUTRITIONIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 W ROY ST APT 411
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-3887
Mailing Address - Country:US
Mailing Address - Phone:509-322-8167
Mailing Address - Fax:
Practice Address - Street 1:119 W ROY ST APT 411
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119-3887
Practice Address - Country:US
Practice Address - Phone:509-322-8167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANU61366449133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist