Individual
BLAKLEY E JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
1 CHILDRENS PLZ, DAYTON, OH 45404-1873
(937) 641-4762
Mailing address
PO BOX 933432, CLEVELAND, OH 44193-0039
(937) 641-4000
(937) 641-4500
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
026091
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0480186
—
OH
Enumeration date
08/18/2017
Last updated
10/31/2024
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