Provider Demographics
NPI:1609680024
Name:JORDAN, JONOVA PASSION
Entity type:Individual
Prefix:
First Name:JONOVA
Middle Name:PASSION
Last Name:JORDAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9477 FORT ASHBY RD
Mailing Address - Street 2:
Mailing Address - City:KEYSER
Mailing Address - State:WV
Mailing Address - Zip Code:26726-6262
Mailing Address - Country:US
Mailing Address - Phone:304-359-5340
Mailing Address - Fax:
Practice Address - Street 1:9477 FORT ASHBY RD
Practice Address - Street 2:
Practice Address - City:KEYSER
Practice Address - State:WV
Practice Address - Zip Code:26726-6262
Practice Address - Country:US
Practice Address - Phone:304-359-5340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant