Provider Demographics
NPI:1972498889
Name:JORDAN, TWANNA M
Entity type:Individual
Prefix:
First Name:TWANNA
Middle Name:M
Last Name:JORDAN
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:PO BOX 6225
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43206-0225
Mailing Address - Country:US
Mailing Address - Phone:614-999-5795
Mailing Address - Fax:
Practice Address - Street 1:793 S 22ND ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43206-1501
Practice Address - Country:US
Practice Address - Phone:614-999-5795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
347C00000X
OH191083164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No347C00000XTransportation ServicesPrivate Vehicle