Doctor Name: | AMANDA JORDAN |
NPI Number: | 1003280843 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 56108 |
Business Practice Address: | 200 Elizabeth St Charleston, WV - 253112119 |
Business Phone Number: | 3043487770 |
Business Fax Number: | |
Mailing Address: | 501 22nd St, DUNBAR |
State: | WV |
Postal Code: | 250641711 |
Phone Number: | 3047667655 |
Fax Number: | |
NPI Enumeration Date: | 11/17/2015 |
NPI Last Update Date: | 11/17/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 163WS0200X |
License Number: | 56108 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WV |
Taxonomy Type: | Nursing Service Providers |
Taxonomy Classification: | Registered Nurse |
Taxonomy Specialization: | School |
Taxonomy Definition: |