Individual
JORDAN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
276 MANCHESTER AVE, WABASH, IN 46992-1808
(260) 563-2126
Mailing address
247 MANCHESTER AVE, WABASH, IN 46992-1806
(260) 563-2126
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28212749A
IN
363L00000X
Nurse Practitioner
Primary
71009859A
IN
Other
Enumeration date
03/02/2020
Last updated
11/02/2022
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