Provider Demographics
NPI:1689409971
Name:NORMAN, JORDAN (LPN)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:NORMAN
Suffix:
Gender:F
Credentials:LPN
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 337
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44871-0337
Mailing Address - Country:US
Mailing Address - Phone:567-290-2658
Mailing Address - Fax:567-246-2424
Practice Address - Street 1:4317 ST RT 269 S
Practice Address - Street 2:
Practice Address - City:CASTALIA
Practice Address - State:OH
Practice Address - Zip Code:44824-9354
Practice Address - Country:US
Practice Address - Phone:567-290-2658
Practice Address - Fax:567-246-2424
Is Sole Proprietor?:No
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.187795164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse