Provider Demographics
NPI:1396159398
Name:JORDAN, MARILYN KIMBERLY (RN)
Entity type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:KIMBERLY
Last Name:JORDAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 SE 168TH AVE
Mailing Address - Street 2:APT 7
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-2101
Mailing Address - Country:US
Mailing Address - Phone:360-975-8667
Mailing Address - Fax:
Practice Address - Street 1:3100 SE 168TH AVE
Practice Address - Street 2:APT 7
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-2101
Practice Address - Country:US
Practice Address - Phone:360-975-8667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-17
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60321388163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse