Provider Demographics
NPI:1134943947
Name:JORDAN, LARONDA ANISE
Entity type:Individual
Prefix:
First Name:LARONDA
Middle Name:ANISE
Last Name:JORDAN
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 1:5533 BRUSH CREEK DR
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-6638
Mailing Address - Country:US
Mailing Address - Phone:614-886-1378
Mailing Address - Fax:
Practice Address - Street 1:5533 BRUSH CREEK DR
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-6638
Practice Address - Country:US
Practice Address - Phone:614-886-1378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-09
Last Update Date:2024-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty