Provider Demographics
NPI:1205691433
Name:JORDAN, DARRIAN DEANGELIS
Entity type:Individual
Prefix:
First Name:DARRIAN
Middle Name:DEANGELIS
Last Name:JORDAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 PINEHURST LN
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-4530
Mailing Address - Country:US
Mailing Address - Phone:319-429-3179
Mailing Address - Fax:
Practice Address - Street 1:1705 PINEHURST LN
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-4530
Practice Address - Country:US
Practice Address - Phone:319-429-3179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-16
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care