Provider Demographics
NPI:1649642968
Name:JORDAN, FELICIA
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2949 VAN AKEN BLVD
Mailing Address - Street 2:APT.1
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44120-2279
Mailing Address - Country:US
Mailing Address - Phone:216-556-3138
Mailing Address - Fax:
Practice Address - Street 1:2949 VAN AKEN BLVD
Practice Address - Street 2:APT.1
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44120-2279
Practice Address - Country:US
Practice Address - Phone:216-556-3138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-26
Last Update Date:2015-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH154274374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH154274OtherOHIO STATE INDEPENDENT PROVIDER