Provider Demographics
NPI:1356453344
Name:JORDAN, LUCY (RN BSN)
Entity type:Individual
Prefix:MS
First Name:LUCY
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:MS
Other - First Name:LUCY
Other - Middle Name:
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN BSN
Mailing Address - Street 1:5288 SWEETGUM PL
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229
Mailing Address - Country:US
Mailing Address - Phone:614-898-7162
Mailing Address - Fax:614-794-3830
Practice Address - Street 1:5288 SWEETGUM PL
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229
Practice Address - Country:US
Practice Address - Phone:614-898-7162
Practice Address - Fax:614-794-3830
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN279868374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2110245Medicaid