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Individual

JORDAN IBRAHIM CUSICK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
1550 N 115TH ST, SEATTLE, WA 98133-8401
(877) 694-4677
Mailing address
3546 S GRAHAM ST, SEATTLE, WA 98118-3126
(626) 993-4988

Taxonomy

Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
RN61004355
WA
363LA2100X
Acute Care Nurse Practitioner
Primary
AP70035123
WA

Other

Enumeration date
05/08/2024
Last updated
04/22/2026
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