Individual
MR. JAY DANIEL JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
612 MOCKSVILLE AVE, SALISBURY, NC 28144-2732
(704) 210-5661
(704) 210-5660
Mailing address
4605 MEETING HOUSE LN, CLEMMONS, NC 27012-7706
(336) 778-1879
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
47466
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
430044434
RR MEDICARE
NC
05
—
8051110
—
NC
Enumeration date
07/07/2006
Last updated
10/27/2020
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