Provider Demographics
NPI:1891816336
Name:JORDAN, JENNIFER ANN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ANN
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6152 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILKINSON
Mailing Address - State:IN
Mailing Address - Zip Code:46186-9640
Mailing Address - Country:US
Mailing Address - Phone:317-345-3473
Mailing Address - Fax:
Practice Address - Street 1:6152 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WILKINSON
Practice Address - State:IN
Practice Address - Zip Code:46186-9640
Practice Address - Country:US
Practice Address - Phone:317-345-3473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27053344A164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse