Provider Demographics
NPI:1134528953
Name:SILCOX, JORDAN (LPN)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:SILCOX
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 1:1492 STROUP RD
Mailing Address - Street 2:
Mailing Address - City:ATWATER
Mailing Address - State:OH
Mailing Address - Zip Code:44201-9397
Mailing Address - Country:US
Mailing Address - Phone:330-257-4615
Mailing Address - Fax:
Practice Address - Street 1:11885 NAVARRE RD SW
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:OH
Practice Address - Zip Code:44662-9485
Practice Address - Country:US
Practice Address - Phone:330-767-3444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.133434-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse