Provider Demographics
NPI:1760258735
Name:JORDAN, LOGAN JEFFREY (RN)
Entity Type:Individual
Prefix:
First Name:LOGAN
Middle Name:JEFFREY
Last Name:JORDAN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9480 MCGLADE SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:DRESDEN
Mailing Address - State:OH
Mailing Address - Zip Code:43821-9742
Mailing Address - Country:US
Mailing Address - Phone:740-624-9977
Mailing Address - Fax:
Practice Address - Street 1:9105 CEDAR AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-2931
Practice Address - Country:US
Practice Address - Phone:216-445-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-30
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.510002163WE0003X
OHAPRN.CNP.0035780363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency