Provider Demographics
NPI:1912377698
Name:JORDAN, SILVANA (LMT)
Entity Type:Individual
Prefix:
First Name:SILVANA
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:SILVANA
Other - Middle Name:C
Other - Last Name:FLORES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4112 MENDENHALL BLVD
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-8916
Mailing Address - Country:US
Mailing Address - Phone:907-419-0518
Mailing Address - Fax:
Practice Address - Street 1:2243 JORDAN AVE
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-8050
Practice Address - Country:US
Practice Address - Phone:907-790-3371
Practice Address - Fax:907-790-2102
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101566225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist