Provider Demographics
NPI:1851193528
Name:GREEN, JORDAN RANEE
Entity type:Individual
Prefix:MISS
First Name:JORDAN
Middle Name:RANEE
Last Name:GREEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3463 APPLE PIE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WELLSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26070-2417
Mailing Address - Country:US
Mailing Address - Phone:304-639-5976
Mailing Address - Fax:
Practice Address - Street 1:37 GRANDE MEADOWS DR STE 250
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-9035
Practice Address - Country:US
Practice Address - Phone:304-598-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV110151163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse