Provider Demographics
NPI:1780332965
Name:JORDAN, MARY T
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:T
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 1:19383 STATE ROUTE 328
Mailing Address - Street 2:
Mailing Address - City:NEW PLYMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45654-9638
Mailing Address - Country:US
Mailing Address - Phone:740-583-0237
Mailing Address - Fax:
Practice Address - Street 1:19383 STATE ROUTE 328
Practice Address - Street 2:
Practice Address - City:NEW PLYMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45654-9638
Practice Address - Country:US
Practice Address - Phone:740-583-0237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide