Provider Demographics
NPI:1649754979
Name:REMCHUK, JORDAN ELISE (CNA, LVN, ADN RN)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:ELISE
Last Name:REMCHUK
Suffix:
Gender:F
Credentials:CNA, LVN, ADN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 BOWIE CIR
Mailing Address - Street 2:
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76801-6552
Mailing Address - Country:US
Mailing Address - Phone:254-214-1584
Mailing Address - Fax:
Practice Address - Street 1:113 BOWIE CIR
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-6552
Practice Address - Country:US
Practice Address - Phone:254-214-1584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-22
Last Update Date:2018-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX901666163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse