Individual
MS. IVY JUSTINE JORDAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.P.N.
Contact information
Practice address
105 WERTZ AVE NW APT 7, CANTON, OH 44708-4100
(330) 452-1539
Mailing address
105 WERTZ AVE NW APT 7, CANTON, OH 44708-4100
(330) 452-1539
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN 106915
OH
Other
Enumeration date
06/13/2007
Last updated
01/11/2011
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