Provider Demographics
NPI:1720420359
Name:JORDAN, LAURA J (CRNA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:J
Last Name:JORDAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:J
Other - Last Name:BRIDGES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DAVIS
Mailing Address - Street 1:140 ACADEMY ST
Mailing Address - Street 2:
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-3102
Mailing Address - Country:US
Mailing Address - Phone:207-768-4314
Mailing Address - Fax:207-976-8439
Practice Address - Street 1:140 ACADEMY ST
Practice Address - Street 2:
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-3102
Practice Address - Country:US
Practice Address - Phone:207-768-4314
Practice Address - Fax:207-768-4390
Is Sole Proprietor?:No
Enumeration Date:2013-07-24
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERNA133019367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered