Provider Demographics
NPI:1689169815
Name:JORDAN, JENNIFER LUVENIA
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LUVENIA
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 1:701 SHADY MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:GLENN HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:75154-7923
Mailing Address - Country:US
Mailing Address - Phone:972-697-9713
Mailing Address - Fax:
Practice Address - Street 1:701 SHADY MEADOW LN
Practice Address - Street 2:
Practice Address - City:GLENN HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:75154-7923
Practice Address - Country:US
Practice Address - Phone:972-697-9713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-29
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Multi-Specialty