Provider Demographics
NPI:1902612435
Name:LEE, JORDAN
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:LEE
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 1:151 MICHAEL ST
Mailing Address - Street 2:
Mailing Address - City:AMA
Mailing Address - State:LA
Mailing Address - Zip Code:70031-2151
Mailing Address - Country:US
Mailing Address - Phone:601-218-6444
Mailing Address - Fax:
Practice Address - Street 1:151 MICHAEL ST
Practice Address - Street 2:
Practice Address - City:AMA
Practice Address - State:LA
Practice Address - Zip Code:70031-2151
Practice Address - Country:US
Practice Address - Phone:601-218-6444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS919074163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse