Provider Demographics
NPI:1831701093
Name:WILLIAMS, JORDAN LEIGH
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:LEIGH
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:LEIGH
Other - Last Name:FANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6901 E CHAUNCEY LN APT 3169
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85054-5146
Mailing Address - Country:US
Mailing Address - Phone:928-284-8770
Mailing Address - Fax:
Practice Address - Street 1:6901 E CHAUNCEY LN APT 3169
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85054-5146
Practice Address - Country:US
Practice Address - Phone:928-284-8770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN200778163WP0218X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0218XNursing Service ProvidersRegistered NursePediatric Oncology