Provider Demographics
NPI:1780484204
Name:JORDAN, MADISON
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:JORDAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 E 6TH ST APT B
Mailing Address - Street 2:
Mailing Address - City:CRETE
Mailing Address - State:NE
Mailing Address - Zip Code:68333-2901
Mailing Address - Country:US
Mailing Address - Phone:401-418-0334
Mailing Address - Fax:
Practice Address - Street 1:1118 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:NE
Practice Address - Zip Code:68343-2342
Practice Address - Country:US
Practice Address - Phone:402-418-4934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health