Provider Demographics
NPI:1790382034
Name:STUTZMAN, JORDAN
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:STUTZMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 YORK DR
Mailing Address - Street 2:
Mailing Address - City:ROMNEY
Mailing Address - State:WV
Mailing Address - Zip Code:26757-6276
Mailing Address - Country:US
Mailing Address - Phone:304-359-0707
Mailing Address - Fax:
Practice Address - Street 1:1492 PURGITSVILLE PIKE
Practice Address - Street 2:
Practice Address - City:PURGITSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26852-8806
Practice Address - Country:US
Practice Address - Phone:304-289-3478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant