# JORDAN IBRAHIM CUSICK

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1356199913
- **Gender:** Man

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163WM0705X | Medical-Surgical Registered Nurse | RN61004355 | WA | — |
| 363L00000X | Nurse Practitioner | ARNP.AP.70035123-NP | WA | Yes |
| 363LA2100X | Acute Care Nurse Practitioner | AP70035123 | WA | Yes |
| 363LA2100X | Acute Care Nurse Practitioner | ARNP.AP.70035123-NP | WA | — |

## Other

- **Enumeration date:** 05/08/2024
- **Last updated:** 07/21/2026