Individual
TYLER RAY JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1006 SUNSET TER, MILTON, WV 25541-1039
(304) 743-6913
Mailing address
1006 SUNSET TER, MILTON, WV 25541-1039
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
79302
WV
Other
Enumeration date
02/12/2011
Last updated
02/12/2011
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