Provider Demographics
NPI:1568197861
Name:LUZIER, JORDAN (PRSS)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:LUZIER
Suffix:
Gender:M
Credentials:PRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 GRAND ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26501-6607
Mailing Address - Country:US
Mailing Address - Phone:304-239-1214
Mailing Address - Fax:
Practice Address - Street 1:25208 GEORGE WASHINGTON HWY
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:WV
Practice Address - Zip Code:26705-8036
Practice Address - Country:US
Practice Address - Phone:304-376-9349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19-908175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist