Provider Demographics
NPI:1780038273
Name:JOURDAN, NATALIE (RN)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:JOURDAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 PROSPECT PL
Mailing Address - Street 2:APT#4I
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-4266
Mailing Address - Country:US
Mailing Address - Phone:914-497-7636
Mailing Address - Fax:
Practice Address - Street 1:545 PROSPECT PL
Practice Address - Street 2:APT#4I
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-4266
Practice Address - Country:US
Practice Address - Phone:914-497-7636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY620368163W00000X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health