Provider Demographics
NPI:1184509226
Name:JORDAN, LILLIE MAE (RN)
Entity type:Individual
Prefix:MS
First Name:LILLIE MAE
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7133 N LOMBARD ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-3205
Mailing Address - Country:US
Mailing Address - Phone:971-506-4697
Mailing Address - Fax:
Practice Address - Street 1:58401 LINDSAY LN
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OR
Practice Address - Zip Code:97053-9303
Practice Address - Country:US
Practice Address - Phone:971-346-6314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-07
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR092000RN4RN163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health