Provider Demographics
NPI:1871580506
Name:JORDAN, SUSAN K (CNP)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:K
Last Name:JORDAN
Suffix:
Gender:F
Credentials:CNP
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Mailing Address - Street 1:4940 COTTONVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JAMESTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45335-1522
Mailing Address - Country:US
Mailing Address - Phone:937-675-6830
Mailing Address - Fax:937-675-6835
Practice Address - Street 1:4940 COTTONVILLE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:JAMESTOWN
Practice Address - State:OH
Practice Address - Zip Code:45335-1522
Practice Address - Country:US
Practice Address - Phone:937-675-6830
Practice Address - Fax:937-675-6835
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2016-06-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OHCOA05329NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2360270Medicaid
OH2360270Medicaid
S92085Medicare UPIN