Provider Demographics
NPI:1649521212
Name:JORDAN-SHOOK, ELIZABETH SUSAN (MED)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:SUSAN
Last Name:JORDAN-SHOOK
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 BLAIR PARK RD
Mailing Address - Street 2:STE. 240
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495
Mailing Address - Country:US
Mailing Address - Phone:802-876-5315
Mailing Address - Fax:802-876-6291
Practice Address - Street 1:600 BLAIR PARK RD
Practice Address - Street 2:STE. 240
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495
Practice Address - Country:US
Practice Address - Phone:802-876-5315
Practice Address - Fax:802-876-6291
Is Sole Proprietor?:No
Enumeration Date:2012-09-24
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator