Provider Demographics
NPI:1205673563
Name:COOK, JORDAN (RN)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:COOK
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N WOLFE ST APT 222
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21231-1684
Mailing Address - Country:US
Mailing Address - Phone:801-560-9428
Mailing Address - Fax:
Practice Address - Street 1:101 N WOLFE ST APT 222
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21231-1684
Practice Address - Country:US
Practice Address - Phone:801-560-9428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-12
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9275639-3102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse