Individual
MS. BRENDA MAE JORDAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
6619 S LAWRENCE ST, TACOMA, WA 98409-4012
(253) 678-1861
Mailing address
6619 S LAWRENCE ST, TACOMA, WA 98409-4012
(253) 678-1861
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA00020952
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA00020952
LMP
WA
Enumeration date
07/19/2007
Last updated
07/19/2007
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