Provider Demographics
NPI:1043970320
Name:JORDON, NIGEL WAYNE
Entity type:Individual
Prefix:
First Name:NIGEL
Middle Name:WAYNE
Last Name:JORDON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3287 STORMY CREEK DR SE
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49512-7902
Mailing Address - Country:US
Mailing Address - Phone:616-551-1452
Mailing Address - Fax:616-710-5769
Practice Address - Street 1:2215 BENTBROOK CT SE
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49508-6313
Practice Address - Country:US
Practice Address - Phone:616-246-1144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-28
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAS4104093673104A0625X
MIAS4103117283104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness