Provider Demographics
NPI:1922061241
Name:JORDAN, ELIZABETH H (WHNP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:H
Last Name:JORDAN
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 S CAMPBELL AVE
Mailing Address - Street 2:BUILDING 2
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85614-0503
Mailing Address - Country:US
Mailing Address - Phone:520-407-5600
Mailing Address - Fax:520-407-5990
Practice Address - Street 1:1260 S CAMPBELL AVE
Practice Address - Street 2:BUILDING 2
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-0503
Practice Address - Country:US
Practice Address - Phone:520-407-5600
Practice Address - Fax:520-407-5990
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2013-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN133939363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000560286001OtherBC/BS COMM BLUE
BB9585Medicare ID - Type Unspecified
067531Medicare ID - Type Unspecified
NY000560286001OtherBC/BS COMM BLUE