Provider Demographics
NPI:1699483610
Name:JORDAN, REBECCA (MLS)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MLS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7002 STRICKLAND ST
Mailing Address - Street 2:
Mailing Address - City:COBBTOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30420-5048
Mailing Address - Country:US
Mailing Address - Phone:406-671-6536
Mailing Address - Fax:
Practice Address - Street 1:7002 STRICKLAND ST
Practice Address - Street 2:
Practice Address - City:COBBTOWN
Practice Address - State:GA
Practice Address - Zip Code:30420-5048
Practice Address - Country:US
Practice Address - Phone:406-671-6536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-08
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist