Provider Demographics
NPI:1487397303
Name:SLEIGHT, JORDAN R
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:R
Last Name:SLEIGHT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6541 AMANDA MICHELLE LN
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89086-1341
Mailing Address - Country:US
Mailing Address - Phone:619-218-0677
Mailing Address - Fax:
Practice Address - Street 1:6541 AMANDA MICHELLE LN
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89086-1341
Practice Address - Country:US
Practice Address - Phone:619-218-0677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV247200000X
247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other