Provider Demographics
NPI:1265160360
Name:JORDAN, SHACRESHA W (NURSE)
Entity type:Individual
Prefix:MRS
First Name:SHACRESHA
Middle Name:W
Last Name:JORDAN
Suffix:
Gender:F
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16911 CAIRNGALE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-2533
Mailing Address - Country:US
Mailing Address - Phone:832-243-7852
Mailing Address - Fax:
Practice Address - Street 1:16911 CAIRNGALE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-2533
Practice Address - Country:US
Practice Address - Phone:832-243-7852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX324759164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Single Specialty