Provider Demographics
NPI:1730440389
Name:JORDAN, JENNIFER (LPN)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 SCARBOROUGH LN STE B
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-5151
Mailing Address - Country:US
Mailing Address - Phone:845-337-0288
Mailing Address - Fax:
Practice Address - Street 1:31 SCARBOROUGH LN STE B
Practice Address - Street 2:
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-5151
Practice Address - Country:US
Practice Address - Phone:845-337-0288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302716164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse