Provider Demographics
NPI:1639670151
Name:JORDAN, RITA
Entity Type:Individual
Prefix:
First Name:RITA
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 1:10179 FM 1226 S
Mailing Address - Street 2:
Mailing Address - City:HAWLEY
Mailing Address - State:TX
Mailing Address - Zip Code:79525-2813
Mailing Address - Country:US
Mailing Address - Phone:325-668-3522
Mailing Address - Fax:
Practice Address - Street 1:10179 FM 1226 S
Practice Address - Street 2:
Practice Address - City:HAWLEY
Practice Address - State:TX
Practice Address - Zip Code:79525-2813
Practice Address - Country:US
Practice Address - Phone:325-668-3522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant