Provider Demographics
NPI:1255127908
Name:JORDAN, HEATHER D (MSN RN)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:D
Last Name:JORDAN
Suffix:
Gender:
Credentials:MSN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16760 ARTISTIC DR # A
Mailing Address - Street 2:
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920-8964
Mailing Address - Country:US
Mailing Address - Phone:330-383-2288
Mailing Address - Fax:
Practice Address - Street 1:425 W 5TH ST # A
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-2498
Practice Address - Country:US
Practice Address - Phone:330-383-2288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-18
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN592595163WA2000X
OHRN-421180163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator