Provider Demographics
NPI:1700199825
Name:JORDAN, PATTI (ARNP)
Entity Type:Individual
Prefix:
First Name:PATTI
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:PATTI
Other - Middle Name:
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5612 176TH ST E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-9304
Mailing Address - Country:US
Mailing Address - Phone:253-875-7600
Mailing Address - Fax:
Practice Address - Street 1:5612 176TH ST E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-9304
Practice Address - Country:US
Practice Address - Phone:253-875-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-18
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00169601163W00000X
WAAP60194886363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse