Individual
MRS. MARY LEE JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
3851 N RIVER RD, WEST LAFAYETTE, IN 47906
(765) 464-2280
(765) 464-2279
Mailing address
713 SHADY CREEK DR, LAFAYETTE, IN 47905-7510
(765) 446-7911
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
28150559A
IN
Other
Enumeration date
08/19/2006
Last updated
07/08/2007
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