Provider Demographics
NPI:1881954402
Name:JORDAN, CRISHON ALVETTA (HOME HEALTH AIDE)
Entity type:Individual
Prefix:MS
First Name:CRISHON
Middle Name:ALVETTA
Last Name:JORDAN
Suffix:
Gender:F
Credentials:HOME HEALTH AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1339 SARATOGA AVE NE
Mailing Address - Street 2:APT # 1
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20018-1952
Mailing Address - Country:US
Mailing Address - Phone:202-569-4615
Mailing Address - Fax:
Practice Address - Street 1:1339 SARATOGA AVE NE
Practice Address - Street 2:APT # 1
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-1952
Practice Address - Country:US
Practice Address - Phone:202-569-4615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-17
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide