Provider Demographics
NPI:1427341957
Name:JORDAN, HEATHER M (BA)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:M
Last Name:JORDAN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2312 N GREEN VALLEY PKWY
Mailing Address - Street 2:#711
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-3107
Mailing Address - Country:US
Mailing Address - Phone:773-934-3294
Mailing Address - Fax:
Practice Address - Street 1:2312 N GREEN VALLEY PKWY
Practice Address - Street 2:#711
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-3107
Practice Address - Country:US
Practice Address - Phone:773-934-3294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner