Individual
MARY-ANGELA JORDAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DTR
Contact information
Practice address
12112 W TETHER TRL, PEORIA, AZ 85383-5872
(480) 267-8767
Mailing address
12112 W TETHER TRL, PEORIA, AZ 85383-5872
(480) 267-8767
Taxonomy
Speciality
Code
Description
License number
State
136A00000X
Registered Dietetic Technician
Primary
—
—
Other
Enumeration date
11/27/2023
Last updated
12/03/2023
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