Provider Demographics
NPI:1013778620
Name:JOURDAN, ELLA
Entity Type:Individual
Prefix:
First Name:ELLA
Middle Name:
Last Name:JOURDAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 MARKIE DR
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-6736
Mailing Address - Country:US
Mailing Address - Phone:985-264-9787
Mailing Address - Fax:
Practice Address - Street 1:520 MARKIE DR
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-6736
Practice Address - Country:US
Practice Address - Phone:985-264-9787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program