Provider Demographics
NPI:1689697906
Name:JORDAN, MARCIA L (MS)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:L
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:950 N MERIDIAN ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204-1077
Mailing Address - Country:US
Mailing Address - Phone:317-962-4836
Mailing Address - Fax:317-962-4812
Practice Address - Street 1:1633 N CAPITOL AVE
Practice Address - Street 2:SUITE 700
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1261
Practice Address - Country:US
Practice Address - Phone:317-962-2915
Practice Address - Fax:317-962-2455
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN71001095363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner