Provider Demographics
NPI:1538371158
Name:JORDAN, LORRETTA RACHIEL (CNA)
Entity type:Individual
Prefix:MS
First Name:LORRETTA
Middle Name:RACHIEL
Last Name:JORDAN
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20249 E PURDUE PL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-6073
Mailing Address - Country:US
Mailing Address - Phone:720-217-3911
Mailing Address - Fax:303-617-5673
Practice Address - Street 1:20249 E PURDUE PL
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80013-6073
Practice Address - Country:US
Practice Address - Phone:720-217-3911
Practice Address - Fax:303-617-5673
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO514335376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide