Provider Demographics
NPI:1326851759
Name:JORDAN, MCKENZIE ANIESE
Entity type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:ANIESE
Last Name:JORDAN
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 1:426 COVE HARBOUR DR W
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:OH
Mailing Address - Zip Code:43528-8019
Mailing Address - Country:US
Mailing Address - Phone:419-276-9126
Mailing Address - Fax:
Practice Address - Street 1:426 COVE HARBOUR DR W
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43528-8019
Practice Address - Country:US
Practice Address - Phone:419-276-9126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care