Provider Demographics
NPI:1194352674
Name:JOURDAN, DANIEL NICHOLAS (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:NICHOLAS
Last Name:JOURDAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 WESTHAVEN RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-6747
Mailing Address - Country:US
Mailing Address - Phone:919-998-8240
Mailing Address - Fax:
Practice Address - Street 1:2799 W GRAND BOULEVARD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2608
Practice Address - Country:US
Practice Address - Phone:313-916-1553
Practice Address - Fax:313-916-7467
Is Sole Proprietor?:No
Enumeration Date:2020-03-25
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program