Provider Demographics
NPI:1801501721
Name:JORDAN, ROBERT HENRY III (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:HENRY
Last Name:JORDAN
Suffix:III
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:292 LONG RIDGE RD STE 104
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-1627
Mailing Address - Country:US
Mailing Address - Phone:203-276-8575
Mailing Address - Fax:203-276-8576
Practice Address - Street 1:292 LONG RIDGE RD STE 104
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-1627
Practice Address - Country:US
Practice Address - Phone:203-276-8575
Practice Address - Fax:203-276-8576
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT10452363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health