Provider Demographics
NPI:1982697736
Name:JORDAN, GLORIA J (PAC MHS)
Entity Type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:J
Last Name:JORDAN
Suffix:
Gender:F
Credentials:PAC MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:104 TILGHMAN DR
Mailing Address - Street 2:
Mailing Address - City:DUNN
Mailing Address - State:NC
Mailing Address - Zip Code:28334-5510
Mailing Address - Country:US
Mailing Address - Phone:910-892-1333
Mailing Address - Fax:910-892-2757
Practice Address - Street 1:104 TILGHMAN DRIVE
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-5510
Practice Address - Country:US
Practice Address - Phone:910-892-1333
Practice Address - Fax:910-892-2757
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC101094363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant