Provider Demographics
NPI:1831248384
Name:JORDAN, PATRICIA ANN (LPN)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:ANN
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:JORDAN
Other - Last Name:WEATHINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:2322 E ROESER RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85040-3405
Mailing Address - Country:US
Mailing Address - Phone:480-216-2199
Mailing Address - Fax:
Practice Address - Street 1:2322 E ROESER RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85040-3405
Practice Address - Country:US
Practice Address - Phone:480-216-2199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 176064164X00000X
AZLP036459164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARVN000620Medicaid
CAEPS010880Medicaid